10 F I S I O T E R A P I E MAART 1979 T h e y do m a n y tra n s itio n a l tu rn s ra n g in g fro m th e s te m ch ristia n ia to th e s te p turn. O n ly la te r will th e y m a s te r p a ra lle l turns. A f te r 12 years w e h a v e fo u n d th a t m a n y o f th e slig h tly h a n d ic a p p e d c e re b ra l p a lsie d c h ild re n c a n e n jo y easy d o w n h ill ru n s. Q u ite a n u m b e r o f th e m a re a b le to m a s te r ru n s o f m e d iu m difficulty, ev en lo n g e r o nes a n d a few m a n a g e to ski in d e e p snow . T h e y c a n ski w ith th e ir fa m ily a n d w ith n o n -h a n d ic a p e d c o m p a n io n s T h e b e tte r o n e s a re h e lp e rs a t o u r ski-w eeks. O th e rs less g ifte d f o r d o w n h ill sk iin g , h a v e b e e n ta u g h t and e n jo y c ro s s -c o u n try sk iin g . T o a c h ie v e th is , m o re tr a in in g , w ill-p o w e r a n d en­ d u ra n c e is n e ed e d th a n in n o n -h a n d ic a p p e d c h ild ren b u t th e re su lts a re w e ll-w o rth w h ile f o r th o s e w h o take p le a s u re in skiing. SPORT AND THE CHILD WITH A LEARNING DISABILITY G . D . V A N D E R M E R W E , B .A ., B .E d., T .O .D . (Spec. E d .) D ie k in d m e t le e rg e stre m d h e id , u ite e n lo p e n d van aard, v in d d e e ln a m e aan sp o r t d ik w e ls m o e ilik . D it kan egter sy lew e n se rv a rin g verb ree d m ils dit b in n e sy p e rso o n s- m o o n tlik h e d e g e sk ie d . F in a lite it o o r die b e so n d e rh ed e van d e e ln a m e m o e t n o g b e re ik word. T h e c h ild is p re se n te d as a p h y s ic a l-m e n ta l-s p iritu a l w h o le to th e a d u lt re s p o n s ib le f o r h is e d u c a tio n . It is th e d u ty o f th e e d u c a to r, n a m e ly th e p a re n t, te a c h e r, th e r a p is t o r p sy c h o lo g is t to e d u c a te th e c h ild as w hole. T h e s c h o o l e d u ca te s th e ch ild by m ean s o f did ac tic m e th o d s ( tr a n s m ittin g k n o w le d g e), o r ie n ta tio n (e s ta b lis h ­ ing a c h o ic e re fe re n c e ) a n d s o c ia lis a tio n (social m o b ili ­ sa tio n ). T h u s th e c h ild is led to so c ial e m a n c ip a tio n d u rin g sc h o o lin g by c re a tin g o p p o r tu n itie s to e n la rg e h is e x p e rie n c e in a c o m p e titiv e e n v iro n m e n t; to d e v e lo p a so c ial c o n sc ie n c e le a d in g to se lfd is c o v e ry a n d fu lfil­ m e n t; a n d to m e e t th e o p p o s ite sex in a le a rn in g s itu a tio n . S o c ial m o b ility is a c h ie v e d th ro u g h fo rm a l te a c h in g in th e c la ss ro o m , e x tra -c u rric u la r activ ities a n d d e v e lo p ­ m e n t o f a c o m m u n ity s p ir it in w h ic h e x tr a - c u r r ic u la r a c tiv itie s p la y a p a rt. I t is p a r ti c u la r ly w ith e x tr a - c u r r ic u la r a c tiv itie s such a s e is te d d fo d s , d e b a tin g so c ieties o r s p o rt th a t th e c h ild w ith le a rn in g d is a b ility h a s d ifficulty in c o p in g . P a r tic ip a tio n in th ese e x tr a - c u r r ic u la r a c tiv itie s p r e ­ sen ts p ro b le m s a n d m a k e s d e m a n d s o n th e p e rso n c o n c e rn e d w ith th e e d u c a tio n o f su c h c h ild ren . T h e p ro b le m s itu a tio n is in te n sifie d b y th e d iv e rs ity o f le a rn in g d is a b ilitie s . S o m e p u p ils h a v e m u ltip le le a rn in g d is a b ilitie s , w h ic h c a n n o t b e a s c rib e d to a sin g le fa c to r. T h e p u p i l ’s le a rn in g d is a b ility m a y re su lt in : E m o tio n a l d istu rb a n c e s, ex p ressed in b e h a v io u ra l term s su c h as e m o tio n a l im m a tu rity , h y p e ra c tiv ity , pa ssiv ity , a sense o f in se c u rity a n d lac k o f p ro te c tio n , a fe elin g o f in fe rio rity , in fa n tility a n d re g re ssio n . M e n ta l a n d e m o tio n a l crip p lin g e x p re sse d as a lack o f th e fo llo w in g : in itia tiv e a n d d riv e ; sense o f d u ty ; p e rse v e ra n c e , w illp o w er a n d e n d u ra n c e ; re lia b ility a nd re sp o n sib ility ; e x p erien c e o f a u th o rity ; in d e p e n d e n c e a nd c o o p e ra tio n . S o c ia l im m o b ility as a re su lt o f a ggression o r b e ing w ith d ra w n ; b e in g u n c o n tro lle d o r p a ssiv e ; a la c k o f se lfco n fid en c e o r u n re a lis tic b ra v a d o ; c h ee k in e ss; se n si­ tiv ity ; d e stru c tiv e n e ss; ex ce ssiv e je a lo u s y ; a te n d e n c y to p ilfe rin g , tru a n c y a n d lying. I f th e a b o v e is a c c e p te d as g u id a n c e , th en th e fo llo w ­ ing a sp e c ts o f e d u c a tio n , as re g a rd s th e p a r tic ip a tio n in s p o rt b y th e c h ild w ith a le a rn in g d is a b ility , can * H e a d o f D e p a rtm e n t, W e s t R a n d S c h o o l f o r C e re b ra l P a lsied . b e h ig h lig h te d . Acccptance o f own body M a n e x p lo re s h is w o rld th ro u g h h is b o d y . H e m a n ip u la te s h is w o rld a n d , m o v es in it. O n e o f the id ea l g o a ls o f e d u c a tio n is th e a c q u is itio n o f definite s e lfk n o w le d g e b y th e c h ild . T h is can o n ly b e re a lise d if th e ch ild h a s d isc o v e re d h is s itu a tio n in h is w o rld as a w h o le . H o w e v e r, th e c h ild w ill o n ly b e a b le to d is c o v e r h im s e lf b y n o tin g w h a t h a p p e n s in h is w o rld a n d to h im . I t is th e ta s k o f th e e d u c a to r to g u id e a c h ild w ith le a rn in g d isa b ility , w h o is o fte n h a n d ic a p p e d in a p ­ p ro a c h in g h is w o rld , in such a w a y th a t h e d e velops a p o s itiv e se lfim a g e ; a c q u ire s his o w n id e n tity , lea d in g to a c c e p ta n c e o f h is o w n se x u a lity , m e n ta l a b ility and specific ta le n ts ; a rriv e s a t m o ra l ju d g e m e n t o n physical m a tte rs a n d c re a te s r e la tio n s h ip s w ith o th e rs in v a rio u s situ a tio n s . Development o f positive selfim age E s ta b lis h m e n t o f a p o s itiv e se lfim a g e im p lie s k n o w ­ led g e o f th e p e rip h e ra l c o m p o n e n ts o f h is p e rs o n a lity s tru c tu re , such as in te re s t, p o ss ib le so c ial q u a litie s a nd e m o tio n s. T h e c h ild is c a p a b le o f se lfd is ta n c in g , im ­ p ly in g t h a t he ju d g e s h is o w n b e h a v io u r, th a t h e has s e lfk n o w le d g e a n d k n o w s h is o w n d is a b ility a n d a b ility . Establishment o f moral values in relation to the p h y sic ^ W ith d u e re g a rd to th e d e v e lo p m e n t o f th e c h ild ’s m o ra l a w a re n e ss, h is p a r tic i p a ti o n in s p o rt m u s t be g u id e d to w a rd s a c c e p ta n c e o f v a lu e s su c h as a ltru ism , fa irn e s s , to le ra n c e , d is c ip lin e a n d h o n e sty . Creating interpersonal relationships A c q u a in ta n c e w ith th e w o rld o f h is fe llo w m e n d e­ p e n d s on his b e in g m a d e to feel a t h o m e in it. T h e c h ild ’s p a r tic ip a tio n in s p o r t w ill g iv e th e e d u c a to r th e o p p o r tu n ity to g u id e h im so th a t he le a rn s re­ s p o n s ib le fe llo w s h ip a n d a lso to c o m p e te w ith o th e r p u p ils w ithin m o ra l lim its; to a c c e p t a u th o r ity and o rd e r; to u tilise his s p a re tim e in a m e a n in g fu l and c re a tiv e m a n n e r; a n d to a c c e p t a p r o p e r g irl-b o y r e ­ la tio n s h ip . T h e a b o v e a re so m e f e a tu re s to b e ta k e n in to a c c o u n t w h e n th e e d u c a to r p la n s s p o r t f o r th e c h ild w ith le a rn in g d isa b ility . P a r t ic u la r a tte n tio n is n e c e ssa ry to a v o id a s itu a tio n w h e re th e c h ild ’s p a r tic i p a ti o n in s p o r t leads to d e v e lo p m e n t o f a n e g a tiv e se lfim a g e and to f r u s t r a ti o n e x p re sse d as a g g re ssio n , to u n c o n tro lle d b e h a v io u r a n d to la c k o f se lfconfidence. P a r tic ip a tio n R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) MARCH 1979 P H Y S I O T H E R A P Y 11 in s p o rt sh o u ld lead to a se n se o f d u ty , a sh o w o f in i­ tia tiv e a n d d riv e , as well as p e rs e v e ra n c e , w illp o w e r, e n d u ra n c e , r e lia b i lity a n d re s p o n s ib ility . A s p o rt p ro g ra m m e sh o u ld b e p la n n e d so t h a t e ach child c a n p a r tic i p a te w ith in h is lim ita tio n s w h ilst it is still a c c e p ta b le to te a c h e rs a n d th e ra p is ts . T h is is a co m p le x p ro b le m , c o n s id e rin g th a t th e ra p is ts , p sy c h o ­ logists a n d te a c h e rs h a v e b e e n m e e tin g a n n u a lly f o r the p a s t five y e a rs to d e c id e w h e th e r c h ild re n w ith le a rn in g d is a b ility s h o u ld p a r ti c ip a te in s p o rt, w h ic h item s sh o u ld b e in c lu d e d a n d w h a t effect it w o u ld h a v e on th e c h ild re n . T h u s f a r n o c le a r a n sw e r h a s e m e rg e d , as d iv e rs e o p in io n s r e n d e r a s o lu tio n im p o s sib le . T h e a u th o r does n o t d o u b t th e e d u c a tio n a l v a lu e o f s p o rt. I n th e n e a r fu tu re a d e c isio n w ill h a v e to b e ta k e n a b o u t w h ic h item s a re to b e offered, w h o sh o u ld p a r ti c ip a te a n d how a c h ie v e m e n ts s h o u ld b e c a lc u la te d a n d re c o g n iz e d , a lb e it b y m ea n s o f re se a rc h , d isc u ssio n o r tr ia l a n d erro r. Sources 1. G u n te r , C. F . G . (1967): A s p e k te v a n d ie te o re tie s e o p v o e d k u n d e , S te lle n b o sc h . U n iv e r s ite its U itg e w e rs. 2. H a m ilto n , J. H . (1971): D ie v e rs ta n d e lik g e s tre m d e le e rlin g . S te lle n o sc h , U n iv e rs ite its U itg e w e rs. 3. L a n d m a n , W . A ., R o o s , S. G . en L ie b e n b e rg , C. R . ( ........): O p v o e d k u n d e en o p v o e d in g s le e r v ir b e g in ­ n e rs. S te le n b o sc h , U n iv e r s ite its U itg e w e rs. 4. S o n n e k u s, M . C. H . (1978): D i e p sig iese lew e v a n die k in d m e t sp esifiek e le e rg e s tre m d h e d e (In : L e e rlin g e m et spesifieke le e rg e s tre m d h e d e in sk o le v a n die D e p a rte m e n t van N a s io n a le O p v o e d in g . S im p o siu m 11 - 13 O k to b e r 1978). 5. V a n d e r S to e p , F . en van d e r S to e p , O . A . (1968): D id a k tie s e o rie n ta s ie . P r e to r ia . A c ad e m ic a . 6. V a n N ie k e rk , P. A . (1978): W ie is d ie k in d m et spesifieke le e rg e s tre m d h e d e ? (In : L e e rlin g e m et sp e si­ fiek e le e rg e s tre m d h e d e in sk o le v a n d ie D e p a rte m e n t v a n N a s io n a le O p v o e d in g . S im p o s iu m 1 1 - 1 3 O k ­ t o b e r 1978). REPORT ON THE USE OF BIOFEEDBACK J e a n e tte M itc h e ll B.Sc. (P h y s io th e ra p y ), M .Sc. ’n O orsig van d ie jo n g ste U 'eratuur o o r bio te ru g rig tin g en veral lera p eu liese a a n w e n d in g , w o rd gegee. T o e sta n d e w at g e s k ik is vir b e h a n d elin g , m e t o d e s van a a n w e n d in g en seine w o rd g e n o e m . V e r sk e ie stu d ie s w o rd aangehaal m aar geen g e k o n tro lle e rd e stu d ie b e w y s tot d u sv e r sta tis­ tics d ie w aarde van b i o ’.eru g rig tin g nie. B io fe e d b a c k , o r m o re a c c u ra te ly , e le c tro m y o g ra p h ic b io fe e d b a c k , a p p e a r s fro m th e c u rre n t l ite r a tu r e to be a p ro m is in g a n d re la tiv e ly n ew e le c tro th e ra p e u tic m o d a lity . It is u s e d m a in ly f o r th e tre a tm e n t o f n e u r o ­ m u s c u la r d is o rd e rs . I t is a n a d ju n c t to th e m o re c o n ­ v e n tio n a l m e th o d s o f tr e a tm e n t a n d p h y s io th e ra p is ts , w ith th e c o - o p e ra tio n o f b io e n g in e e rs , m a y u se it in ­ c re a sin g ly in th e r e h a b i li ta t io n o f p a tie n ts . H o w e v e r, as îts u s e as su c h in c re a se s, n e w te c h n iq u e s as re g a rd s its A p p lic a tio n w ill n e ed to b e d e v e lo p e d to s u it th e in d i- •Vidual p a tie n t ’s needs. R e c e n t stu d ie s a n d re p o rts o f th e r a p e u t ic successes h a v e sh o w n th a t e le c tro m y o g ra p h ic b io fe e d b a c k , u sed w ith c a re fu lly d ire c te d in s tru c tio n a n d m o tiv a tio n , e n ­ a b les a p a tie n t to o b ta in “ . . . a n e x tr a o r d in a r y d e g ree o f v o lu n ta r y c o n tro l o v e r p h y sio lo g ic a l a c tiv itie s p r e ­ v io u sly c o n sid e re d (to be) in v o lu n ta ry , re fle x iv e o r s u b c o n sc io u s.” (N a fp lio tis , 1976), a n d th is d e g re e o f c o n tro l is o b ta in e d in a re la tiv e ly s h o rt p e r io d o f tim e. E le c tro m y o g ra p h ic b io fe e d b a c k in v o lv e s so m e a u d ito r y o r v isu a l r e p re s e n ta tio n o f a p a tie n t’s m u s c u la r a c tiv ity , w h ic h th e p a tie n t is ta u g h t to m o n ito r in a n a tte m p t to a lte r m u s c u la r a c tiv ity v o lu n ta r ily to a c h ie v e a d e sire d re sp o n se . T h is p ro c e d u re seem s to w o rk e q u a lly well in cases o f fla c c id ity a n d s p a s tic ity (Tnglis e t al., 1976). A p a r t f r o m u se in n e u ro m u s c u la r d is o rd e rs , it has b e e n e x te n d e d to r e tr a in in g c o rre c t m u s c u la r a c tiv ity in c h ro n ic r e s p ir a t o r y c o n d itio n s (J o h n s to n & L ee, 1976), g a it r e tr a in in g in o rth o p a e d ic p ro b le m s (Z im n ic k i & F e m ie , 1976), a n d in r e la x a tio n o f m u sc le sp a sm in te n s io n h e a d a c h e s (B u d z y n sk i et al., 1970) a n d to rtic o llis (B rudny, G ry n b a u m & K o r e in , 1974). I n a p p ly in g th e m e th o d o f e le c tro m y o g ra p h ic b io fe e d - b a c k , a fu ll f u n c tio n a l a sse ssm e n t is m a d e o f th e p a tie n t, w h o is th e n in tro d u c e d to th e a p p a ra tu s . S u rfa c e e le c ­ tro d e s , w h ic h a r e m o s t o fte n u se d , a re a p p lie d to th e sk in a f te r c le a n in g th e a r e a w ith a lc o h o l a n d a c o n d u c ­ tiv e p a s te is u se d to e n s u re p r o p e r e le c tric a l c o n ta ct. T h e ty p e s o f v is u a l a n d /o r a u d ito r y s tim u li to b e e x p e c te d , a n d w h ic h a r e d e sire d to e lic it a v o lu n ta ry re sp o n se , a re e x p la in e d to th e p a tie n t b e f o re a few “ tr ia l r u n s ” a r e c o n d u c te d . T r e a tm e n t se ssio n s la s tin g 30 to 60 m in u te s a r e u su a lly c a r r ie d o u t tw o to th re e tim e s a w eek, a n d c o n tin u e d u n til th e p a tie n t show s so m e g a in in v o lu n ta r y c o n tro l a n d /o r fu n c tio n a l im ­ p ro v e m e n t. R eview o f Current Literature T h e u se o f e le c tro m y o g ra p h ic b io fe e d b a c k w as first r e p o rte d in 1960 as a m e th o d o f n e u ro m u s c u la r r e ­ e d u c a tio n in cases o f h e m ip le g ia (M a rin a c c i & H o r a n d e , 1960). N e e d le e le c tro d e s a n d a u d ito r y fe e d ­ b a c k w e re u se d , firstly on th e u n a ffe c te d lim b in th e in itia l tra in in g . T h e a u th o r s c la im e d a 20% im p ro v e ­ m e n t in th e fu n c tio n o f th e a ffe c te d lim b w ith in o n e h o u r o f tre a tm e n t. I n 1964 A n d re w s r e p o rte d a n o tic e a b le im p ro v e m e n t in th e m o to r u n it a c tiv ity in n o n - f u n c tio n ­ ing m u sc le s in cases o f h e m ip le g ia w ith p a re s is o f f r o m o n e to f o u rte e n y e a rs d u r a tio n . N e e d le e le c tro d e s a n d v isu a l f e e d b a c k w e re u se d . In s im ila r cases o f o n e y e a r d u r a tio n w ith tib ia lis a n te r io r p a resis, n e e d le e le c tro d e s a n d b o th a u d ito r y a n d v isu a l fe e d b a c k w e re used a n d g o o d re s u lts r e p o rte d in 1973 b y Jo h n s o n & G a rto n . S o m e o f th e s e p a tie n ts w e re re p o rte d to im p ro v e to th e e x te n t o f no lo n g e r n e e d in g sh o rt-le g b ra c e s f o r fo o t- d r o p c o n tro l a f te r o n e m o n th ’s tre a tm e n t. S u rfa c e e le c tro d e s a n d v isu a l fe e d b a c k w e re u se d at th e sa m e tim e b y A m a to e t al. (1973), to tr e a t s p a s tic ity o f th e g a s tro c n e m iu s m u sc le g ro u p o f a b o u t n in e y e a rs d u r a tio n . T h e y re p o rte d im p ro v e m e n t a f te r f o u r m o n th s ’ tra in in g , w h ic h w a s m a n ife s te d in som e cases as a h e e l-s trik e to m id -s ta n c e p a tte rn w ith th e fo o t b e in g h e ld flat. S w aa n e t al. (1974) e x te n d e d th e u se o f su rfa c e e le c tro d e s a n d a u d it o r y fe e d b a c k to re d u c e m u sc le sp a stic ity in cases o f h e m ip le g ia a n d , in th e w o rd s of R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )