Page 12 P H Y S I O T H E R A P Y SEPTEM BER, 19 7 3 T H E "H A L L IW IC K " S W IM M IN G M E T H O D FOR THE H A N D IC A P P E D (Adults and C hildren) Developed by the Association o f Sw im m ing Therapy U .K. A. C. Lochau (Physiotherapist (R .N .)) Introduction: A t the opening o f the Selwyn-Segal Home for Jewish H andicapped, in Sandringham , Johannesburg, by the H onourable, the A dm inistrator" o f the Transvaal, M r. S. G. van N iekerk, he pertinently referred to the grow ­ ing realisation th at m any handicapped persons in South A frica could becom e useful citizens by applying special therapies. H e stated that, in 1965, there were some 2 000 educable handicapped in the Republic and noted w ith regret th a t there w ere only nine schools for the h an d i­ capped. R a th e r m ore schools o r institutions were urgently needed to provide the specialized treatm ent he h ad r e ­ ferred to earlier in his speech. A ttention is given to th e handicapped in m ost co u n ­ tries. Schools or hom es have been provided by the State, C hurches and w elfare societies and other assist­ ance is frequently given to help the handicapped and to assist them to becom e as independant and . as useful to the com m unity as possible. In Switzerland, for, example, the Swiss Social Invalid Insurance provides both young and older handicapped persons with the opportunity to visit Spa Clinics annually to receive special free tre a t­ ment. All this w ork is highly commendable, yet it cannot entirely overcom e the position that the handicapped person largely lives in a world apart. His is th e world of appliances and therapies. Especially where he is one o f a fam ily o f norm ally developed children, the h an d i­ capped child becomes aw are of his deficiencies, as p a r­ ticipation in m ost games and sport is usually impossible. T herefore a feeling of isolation can easily develop w ith consequent enduring physical and psychological effects. C onsidering these facts, M r. J. McMillan, a friend of th e H alliw ick School fo r the Handicapped run by the C hurch o f E ngland’s C hildren’s Society and accom m odat­ ing m ainly C erebral Palsied children, conceived the idea th a t it m ight be possible to largely overcome this dis­ parity by inducing the children to participate in w ater sports, th a t is, swim ming or playing games or m erely d is­ porting themselves in w ater. The emphasis was to be placed on the recreational aspect, the pleasure derived from this sport, although, o f course, the therapeutic value m ay n o t be underestim ated. T he id ea was discussed w ith the School’s h o norary surgeon, M r. O. J. V aughan Jackson, F.R.C.S., who gave it his w holehearted support. T h e sponsors o f the scheme were allowed to proceed and in 1950 twelve girls in the age group 9-15 years were elected fo r the first course. The experiment was started w ith enthusiasm , b u t it was realised very soon th at the m ethods adopted to teach normal children to swim, had com paratively little value in this case. A n entirely different approach appeared to be necessary. In th e ensuing m onths m ost attention was therefore devoted to devising suitable teaching methods. Thereafter con­ siderable success was attained, m ore children participated and the “H alliw ick Penguins” Swimming C lub could be established at the school. W orld-w ide interest in the schem e was created by M rL B obarth who visited the school, studied the m ethod and' published her findings. T h ereafter physiotherapists from all over the w orld visited the school and disseminated the idea in their countries. H owever, th e m ost rapid developm ent occurred in the U nited K ingdom . There, o ther clubs fo r handicapped people adopted the ideas and soon so m any clubs were form ed th a t inter-club galas could be arranged. In fact, th e supporters of this new app ro ach found it advisable in 1952 to establish the “A ssociation of Swimming T h erap y ” in th e U nited King­ dom. T h e objects of the A ssociation are: to act as the central co-ordinating organisation, to fram e a uniform code of practice and to act as clearing house fo r the collection and dissem ination o f the experience gained, to strive to im prove m ethods and to devise new m ethods or games to help th e handicapped. T h e present description of the m ethod is based, mainly, on a course given by M r. J. M cM illan and D r. Joan M artin, as guest lecturers at the Swiss Spa-Clinic, Bad R agaz during the spring of 1965. w hich th e present a u th o r was privileged to attend. T h e course consisted firstly o f lectures and practical dem onstrations and later the participants to the course had the opportunity to practise the m ethod, under guidance, on a group of ad u lt handicapped who visited Bad R agaz by arrange­ m ent w ith th e Swiss Invalid Social Insurance. In this discussion the instructor or trainer will generally be referred to as “helper” and the handicapped person a\̂ > “ sw im m er” irrespective of w hether he actually learns to swim, or only to move o r disport him self in water. Prerequisites for success as Helper: In o rder to understand and successfully apply the m ethod, the helper m ust first have a fair know ledge of physics, especially m atters such as force, m om ents and levers, stress and strain, the effects and force of gravity, balance, the properties of w ater and their effects on subm erged bodies, e.g. pressure, buoyancy and o f the theorem s relating to fluids, such as those of A rchim edes and Bernoulli. A ttention should be given to the effects of w ater on the norm al as w ell as the handicapped hu m an body. Secondly, the helper m ust have know ledge o f the hum an body, its anatom y and physiology and in p a r­ ticular of the neuro-m uscular system. In this context the helper should also study the m ental aspect o f the handicapped and his probable reactions when tran sfer­ ring fro m th e m edium air, to w hich he has becom e used to, to the denser medium , w ater. 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. ) The Swimmer’s A spect: The hum an body is constantly subject to th e force o f vitv and has to react to its effect when changing shape ^ m a in ta i n in g m ovem ent through m uscle action. In the ‘‘norm al” medium , air, these reactions have becom e sub- onscious. Sim ilarly breathing is a subconscious action in the medium air. All this n aturally also applies to the handicapped, ually assisted in m aintaining posture or m otion by v a r i o u s types o f appliances. In his case, how ever, there • the experience o f inability fo r action w ithout the 'd is ta n c e o f the p articu lar appliance and a greater sense n f fear o f falling and hurting him self. Since, fo r reasons civen later, these appliances are to be abandoned when fhe swimmer enters w ater, th e helper m ust be very c o n s c i o u s o f this elem ent o f fear in his pupil. The force of gravity still reacts on bodies partly or wholly subm erged in water, b u t in this m edium o f m uch higher density than air, the body experiences a very appreciable u p th ru st acting in a direction opposite to that of the force o f gravity. Since the hum an body has A average density low er than th a t o f w ater, th e relaxed J&dy will actually float in w ater, albeit in m ore o r less a horizontal rath er than upright position. A person entering deep w ater thus has less ap p recia­ tion o f the force o f gravity, indeed m ost o f the fixed points (relative to the m edium air) ap p ear to be lost. As is well know n, w ater, a t any p oint below the su r­ face, exerts pressure equally in all directions, the pressure rising with depth fro m the surface. T h e hum an body, su b m e rg e d in w ater, th erefore experiences m uch higher pressure against th e chest than in air an d th e sub­ conscious p attern o f breathing in the m edium air is affected. A new p attern of breathing m ust therefore be developed. This loss o f the acquired fixed points (in air) an d the hampering of breathing add to the sense of fear or insecurity o f the handicapped person. One m ay o f course add to this the fear arising from gulping or choking in water by inadvertently getting w ater in to the m outh or nose. T he result o f fear is tension w hich is detrim ental to proper m ovem ent in water. T h e first object o f training is therefore to overcom e this fear, and to teach the swimmer to enjoy being in the water. This can be achieved both consciously and su b ­ consciously by devising various games to be played in the water. T h e sw im m er progressively becomes used to water .and its forces, such as th e balance betw een gravity and buoyancy. By learning to swim in th e supine posi- 'ion first, to float an d to recover to a safe breathing SEPTEMBER, 1973 P H Y S I O position, the swimmer gains the necessary confidence fo r independent swimming. T h e tw o m ottos of th e m ethod are th erefo re:— (1) B A L A N C E IS STIL LN E SS! (2) BLOW1 The Application o f the Method: It m ust be stressed at the ou tset th at th e underlying principle o f the m ethod is to provide the handicapped w ith an opportunity to enjoy h im self freely. T h e idea should n o t arise th a t this is an o th er form o f therapy. T h ere m ust therefore be no fo rm o f com pulsion. T h e handicapped should participate quite voluntarily and the swimming should be m ade as norm alised and enjoyable as possible. In order to achieve this, n o appliances, n either those used norm ally by the handicapped or so-called swim­ m ing aids are allowed in this m ethod. T h e swimmers are lifted o n to the side of the pool — e n try is from the side o f th e pool, the helper always close by the swim mer to rem ove all sense o f fear of falling. T h e h elper m ay assist at first, both in entering and getting out o f the pool. T he dissipation o f fear is also achieved by assuring the sw im m er th a t he cannot be h u rt as when falling on land. D row ning need not be feared as th e h elper fo r each swimmer is alw ays close by. F u rth erm o re the fear of drow ning is rem oved by telling th e swim mer th at if he relaxes an d becomes completely still, the w ater will push him to th e surface: “Y ou can n o t stay u nder, even if you w ant to .” ^ T h e swim mer should also be taught from the outset to BLO W when his nose o r m o u th comes n e a r to u n d er the w ater. D uring the training, established ideas from life on land a re used. F o r exam ple, to acquire head control the sw im m er is told: “ Sit on a stool, place your hands on the tab le.” (H e then “ sits” till his shoulders are subm erged — being lightly supported by the helper’s hands on his shoulder-blades. See the sketch.) “N ow lie back on y o u r bed and sleep.” T h e helper (each swim mer m ust, at least in the in itial stages, have his own helper) is always behind o r a t the side o f the swimmer a fte r he has entered the water. W hen behind the swimmer, he lightly places his hands on the sw im ­ m er’s shoulder-blades. H e does n o t hold th e swim mer’s head as it m ust be free to m ove to be able to learn p ro p er head control). H E R A P Y Page 13 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. ) Page 14 P H Y S I O T H E R A P Y SEPTEMBER, 1973 frnjjfty th e S o u th A fr ic a n w a y oS life HEDLEY BYRNE I G row th wath Security SOUTH AFRICAN IPERMANENT I bUILDING SOCIETY G r a n t 2 46 7 /3 A. C. M IL L E R & C O . ORTHOPAEDIC MECHANICIANS Technicians registered with S.A. Medical and Dental Council specialising in the following: O R T H O P A E D IC A P P L IA N C E S , S U R G IC A L C O R S E T S , C E R V IC A L C O L L A R S, C H IL D R E N 'S S H O E S A N D B O O T S, A R T IF IC IA L L IM B S, L A T E S T IN P L A S T IC M O D IF IC A T IO N . H IR IN G A N D SE L L IN G OF H O S P IT A L EQ U IP ­ M E N T A N D S IC K R O O M R E Q U ISIT E S , e.g. W H E E L C H A IR S , C O M M O D E S , H O S P IT A L B E D S, W A L K IN G A ID S , T R A C T IO N A P P A R A T U S , etc. Telephone 23-2496 P.O. Box 3412 275 Bree Street Johannesburg WHtfMBOUT MV flM N C IM r n r n e ? GROUP INSURANCE offers you special benefits at re d u c ed rates including valuable disability benefits. Your financial future is m ore secure when you join YOUR. OWN ASSOCIATION'S SuperannuationFund.lt costs you less to insure the ..G roup" way Fill in and post the coupon below for full particulars of how (j you can benefit from your S.A. NURSING ASSOCIATION’S GROUP INSURANCE SCHEME—all correspondence will b e treated in strict confidence. To the Trustees, S.A. Society of Physiotherapy, Group Endowment Fund, P.O. Box 1194, Johannesburg. Name _____________________ ___________________________ A d d re ss ____________________________________ __________ A g e next birthday____________ Occupation______________ W here employed ______________________________________ How much can you afford to contribute each m onth?___ THE COLONIAL ,0 MUTUAL 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. ) The teaching m ust always be positive. A ll the orders *Y aiso be positive — never use the w ord “D o n ’t ” . T h r o u g h o u t , the teaching aim s a t th e developm ent of h l a n c e control and the m axim um use o f w ater’s buoy- e Thus even if often ra th e r slowly, m ental and physical security develop. Then and then o n ly !, pro p er swimming and diving l e s s o n s may be started. (As indicated already, “ swim­ ming” means any possible m ethod th a t the sw im m er m ay dopt to propel him self independently from one side of the pool to the other, and his ability to regain the s t a n d i n g or a safe position by him self.) I t is essential to exercise great patience — never rush swimmer, even if it m ay take years to accom plish one step forw ard. I t is b etter to spend tw enty lessons on one small p o in t th an to try to rush a “slow” s w i m m e r to keep up w ith the group’s advance. Although it m ay be advisable to tak e a new swimmer to the pool separately fo r the first tw o o r three sessions, in order to assess his ability an d em otional behaviour, the teaching is done in groups. T he n u m b er o f p ar- itip a n ts in a group depends on the size o f the available swimming pool (or the p a rt of it having a reasonable depth, i.e. w here the helper can stand firmly and the swimmer m ay touch the floor when recovering to a standing position) and the n u m b er o f helpers available. It s h o u l d also only be large enough to enable the leader- helper to exercise control o f the w hole gro u p at all times. F o r exam ple, the swim ming pool at the P reto ria School fo r C erebral Palsy (size app roxim ately 15 feet by 20 feet) could only accom m odate 4-5 swim mers as well as their helpers (thus a b o u t 8- 1 0 in each group). One of the helpers acts as leader o f the group. The final grouping o f swimmers is n o t d o n e acco rd ­ ing to age or disability, b u t ra th e r according to each individual’s ability in th e w ater. T h e standard o f ability may not be very obvious, b u t it is essential th a t the members o f each group o f swimmers should have approximately equal ability. Each group has one leader, who controls the activities generally and gives the orders. T h e leader usually remains constant. T h e helpers ensure th a t th e ir respective swimmers participate in .th e activities and overcom e their own specific problem s. T h e leader should be changed frequently, as well as the different helpers, so to avoid emotional attachm ent by a sw im m er to a p articu lar helper. T here are o f course exceptions to this rule, as in cases of difficulty o f com m unication (e.g. deaf o r blind iwimmers and bad cerebral palsied swim mers w ho have (ifficulty in talking). Teaching is done m ainly by playing games sim ilar to those played by n o rm al children on land. Such games can be given the sam e nam es, .e.g. “ A pples and Oranges”, “C at and M ouse” and “ R ing a R ing a R ose” . Each game has some specific objective. T h e swimmers may gain this point subconsciously or, when it appears desirable, they m ay be inform ed w h at is to be achieved. Joyous participation is encouraged. L ots o f shouting and laughter help to relax the swimmers, the co-opera- tion im proves a n d ' a com petitive atm osphere usually develops. In this way m ost o f the im p o rtan t lessons may be learnt. Instruction, through such games, is given in breathing, head control, standing, w alking, jum ping and swinging in static positions (aided by two helpers) — fo r subtle head control — forw ard recovery (to com e to a standing position from supine lying) and rolling recovery (to obtain a safe b reath in g p osture in the supine position). Other lessons are given to create u nderw ater co n ­ fidence as a prelim inary to independent entry in to the water. T hese include practice in som ersaulting and rolling. Finally lessons in pushing off, gliding, sculling with turns, backstroke and o th er strokes are steps to ­ wards the objective o f independent swimming. SEPTEMBER, 1973 Page 15 I t is very essential th a t progress should be m ade. Since this m ay be very slow, the helper m u st have in ­ finite patience. F urtherm ore, it ca n n o t be stressed suffi­ ciently th a t facilities should be available fo r regular training o f swimmers, especially fo r th e beginners, th ro u g h o u t the year. M uch valuable w ork m ay become com pletely undone if the training has to b e suspended fo r long periods — due, fo r exam ple, to cold or rainy w eather. T h e provision of incentives to ensure sustained p r o ­ gress is valuable. P raise and encouragem ent from the helper should never be lacking. Small prizes and p ro ­ vision o f grades, m arked by a rib b o n o r badge have proved useful. T he training of people, w ho a fte r leading a norm al life, including fo r exam ple w ater sports, have become handicapped through som e accident o r disease, presents special problem s. M an y o f these people acquire a fixed idea th a t they will never be ab le to use their lim bs again, and accordingly they are very sceptical when exercises in w ater and swimming are suggested to them . T hey are generally m ore afraid o f entering the w ater than o th er handicapped persons. H ow ever, if they can be persuaded to en ter the w ater and learn again to swim independently they are generally m ore grateful and a lot happier a b o u t th e achievem ent th an o th er handicapped persons, w ho were born with th eir disability. Practical Experience Gained: f T he task m ay seem, even from this brief description, to be form idable. T he potentialities of the m ethod were, how ever, illustrated pertinently during the dem onstra­ tions a t Bad R agaz, m entioned in the introduction, w here only the leader was entirely conversant w ith the course. T h e trainee-helpers had only eight sessions of ab o u t one h o u r each w ith a group of sixteen to tw enty invalids. D uring this sh o rt period m ore than h alf of th e swim mer- pupils learn t to swim independently fairly well. A mong them was a p articularly sceptic young paraplegic, w ho h ad been able to swim b e fo re . his accident and w ould n o t believe th a t he could be trained to swim again. A nother successful sw im m er was a very rigid cerebral palsied quadriplegia (18 years old), w ho had never swum before. T his young m an had only very slight head m ove­ m ents (ab o u t 25% ) and only a b o u t 15° knee and shoulder m ovem ents. Y et he learn t to go in to the supine position by him self, could swim across the pool an d pull him self into the standing position. I t was only a t this juncture th a t he had to be helped to rem ain standing. A t the School fo r C erebral Palsied in P reto ria, there has no t yet been much opportunity to practice the m ethod as th e pool can only be used during the sum m er m onths, provided it does no t rain. T h e w ater is cold, and especially those children w ho are badly disabled get very cold, tense and shivering too soon. A lso the cold w ater m ay be very unpleasant fo r the helpers w ho are virtually static. T h e helpers should keep th e shoulders in th e w ater. T h e few children w ho could be helped w ere as astonished and pleased as th eir therapists at their own progress achieved. Application o f the Method and Progress in U.K.: As the application o f the m ethod is p ro b ab ly m ost advanced in the U .K . a brief description o f develop­ m ents u n d er the auspices of the A ssociation o f Swimming T h erap y m ay serve to indicate the possibilities. Clubs: T he prim e object of the m ethod is to create as norm al an atm osphere fo r the handicapped as possible. C lubs m ay be form ed as soon as a large enough group of participants is available. E ach C lub is given a nam e which specifically should have n o reference to the fact P H Y S I O T H E R A P Y 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. ) Page 16 P H Y S I O T H E R A P Y SEPTEM BER, 1973 th at the swim mers are handicapped persons. Typical nam es a re :— K ensington E m perors Swimming Club. H alliw ick P enguin Swimming Club. Starfish Swimming Club. Crew e Seahorses Swimming Club. M em bership o f a club gives the swimmer the very valuable feeling of “ belonging” . T his is accentuated by the club badge. Rules and Membership: A sh o rt set of rules is necessary for proper order. T he A ssociation has found th a t this can be confined to ab o u t twelve rules. Full m em bership is only available to handicapped people. H elpers, parents and others prepared to help o r support the club in any way, m ay become associate members. Management and Staff: T h e club is usually m anaged by a committee consist­ ing of a President, C hairm an, Secretary and T reasurer (or Secretary-T reasurer) who are “norm al” people of responsibility. T he “staff” consists o f a chief instructor assisted by senior and ju n io r (assisting fo r example in dressing, grouping an d preparing and serving refreshments, as well as tran sp o rt officers (from and to the club and homes). N o n e o f the participants (swimmers, instructors o r helpers) w ear any uniform and to ensure anonim ity— all are only know n by their C hristian names. All “posts” are h o n o rary and staff candidates are accepted, n o t by reason of the fact th a t “ they m ay be sorry fo r the poor little children” but only if they have a genuine desire to help those less fo rtu n ate than themselves; finding their rew ard in the joy they bring to the handicapped and the satisfaction arising from unstinted service. M any assistants com e from the ranks of parents and of organisations such as the St. Jo h n ’s A mbulance, the T refoil G uild, the B.P. G uild, the G irl Guides and Boy Scouts. T hese m ainly assist the swimmers with undress­ ing and dressing, drying of swimmers, as vehicle drivers and acting as escorts on tran sp o rt vehicles. Some be­ com e instructors assisting the trained instructors. Subscriptions and Funds: ', As stated above, all assistants give their services free of charge. Swimming pools are either provided speci­ fically fo r this purpose by local authorities o r public baths m ade available free fo r pre-determined periods. Local authorities also provide free transport fo r swim­ mers and their assistants while organisations such as the R o tary C lubs o r the R ound T able also provide tran s­ p o rt facilities. M any firms also assist by, for example, donating refreshm ents. T he actual club expenditure is therefore quite moderate. N evertheless, there is unavoidable expenditure and it is also considered th at a m oderate club fee adds to the feeling of really “ belonging” to a worthwhile organisa­ tion. T herefore, full senior mem bers pay an annual m em bership fee o f a b o u t 25 cents while juniors p ay 15 cents per annum . T he associate members’ fee is 25 cents p e r annum . D onations are kept in fund fo r arising necessities. Tests: T h e A ssociation has laid dow n a series of tests which swim mers m ust pass fo r prom otion from one grade to another. Som e 24 steps of progression are recognised and a badge or insignia is provided for each grade. Inter-Club Activities: W hile th e provision of generally recognised grades stim ulates the swim mer to individual effort and helps to build up confidence not only in th e swimming pool but, probably subconsciously in all spheres o f his activities’ it was recognised th a t m uch social benefits could accrue by arranging inter-club (i.e. if necessary inter-school) m eetings or galas. O n the one hand a n orm al club o r school-spirit evolves. On the o ther hand, bearing in mind th a t the handicapped children h e a r so m uch a b o u t inter-school galas from th eir n orm al brothers, sisters and friends, th a t the insti­ tu tio n of sim ilar galas tends to give the w hole club move­ m ent a m ore “n o rm al” atm osphere, as well as adding to the prestige of the handicapped in th e ir fam ily circles. A ll races a t galas are swum on a tim e-handicapped basis, as this is the only w ay to give a fair chance to every com petitor. T hus i f fo u r sw im m ers norm ally swim 30 metres in: A: 30 seconds B: 35 seconds C: 65 seconds D: 90 seconds r then D will start a t the signal “ G o ! ” while C, B and \ will follow a t the required intervals, so th a t all would “norm ally” end the race a t the sam e time. In fact, a sw im m er is usually not allow ed to b eat his “norm al” time by m ore than one second p e r ten yards. These galas have becom e very p o p u la r and are well supported. Requirements for Applying the Method in South Africa: F o r training purposes a pool o f ab o u t 20' x 40-50' having a depth of ab o u t 3'-3'6" w ould be adequate. (Bigger pools allow bigger groups o r m o re groups.) It is preferable to have the pool closed in an d provision for m aintaining the w ater tem perature a t ab o u t 80-85°F (26-29°C) is necessary. T he pool, or a t least a b o u t one third o f it, i f it is a large pool, should be reasonably shallow to allow the helper to be able to stand easily during all the training sessions. T he tem perature should be reasonably high constantly to enable training to be continued th ro u g h o u t the year, secondly because the helpers rem ain in the w ater fo r quite extensive periods w ithout being very active, and thirdly because o f the ra th e r poor circulation as well as the inability to be very active often, of the handicapped, so th a t they get cold very quickly. W hile it is helpful to have such specific pools, good use can be m ade o f the shallow ends o f large pools, the deeper ends being used fo r the m ore independent swimmers. Since it is being m ore generally realise^ th a t baths suitable fo r all the y ear use by norm al swim­ mers are becom ing a necessity to ensure the m aintenance and even im provem ent of the high standard o f South A frican swimmers (T ransvaler 21.7.67), it can be sin­ cerely hoped th a t such baths will soon be provided at all im p o rtan t centres in the R epublic and th a t these can then also be m ade available to the handicapped at certain times. Surely, local authorities, o ther organisations and also individuals w ould be p rep ared to assist to provide trans­ port and o ther assistance to launch such a scheme. One w ould have to start with a few clubs only a t first, but in areas such as the W itw atersrand-P retoria complex, C ape T ow n and environs, P o rt E lizabeth and D urban inter-club meetings m ight be instituted in due course. In this article stress has been laid on the recreational aspect. T h e therapeutic effect b o th physically and m en­ tally can n o t be overlooked, however. T herefore the in­ stitution of the scheme should also be of great value in achieving th e objective m entioned by the A dm inistrator in his speech, of striving to develop all the potentialities o f the handicapped so th a t the m axim um num ber possible m ay become independent and useful m em bers of the com m unity. 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. )