Page Ten P H Y S I O T H E R A P Y January, 1954. Preventation of Deformity R eprinted by kin d permission o f “ The British Journal o f Physical M edicine.” A great deal o f time and ingenuity are being expended at present on devices to assist disabled (or partially disabled) persons to live and work in a semblance o f normality, in spite o f their handi­ caps. Such devices range from specially con­ structed sticks and crutches to slinging for paralysed arms, and from wheel-chairs to tongs to pull up on e’s stockings. These efforts are most useful and valuable and should, certainly not be dis­ couraged, for they m ay transform a helpless cripple into a comparatively independent member o f the community. W hat we should, however, be glad to know is whether a comparable am ount o f time, care and ingenuity are being devoted to the prevention o f deformities and disabilities. There is considerable danger o f the development o f what Dr. Francis Bach has called a “wheel-chair mentality’’ in relation to chronic or acute disease o f a potentially crippling nature. After all, any case in which elaborate devices for overcoming deformities are necessary, represents, in som e degree, a failure o f treatment. It is supremely important to tackle the problem as soon as it begins to arise, remembering (as Dr. Hugh Burt told the World Congress for Physical Therapy) that much deformity is pre­ ventable. Prevention o f deformity and preservation o f function can hardly be divided, but it sometimes becomes necessary to put certain limits on function in order to prevent deformity. Part o f the limita­ tion will be quantitative and part o f it qualitative. It might, perhaps, be said that quantitative limita­ tion is m ost important in early rheumatoid arthritis, when rest is indicated. Such movement as is allowed should, however, be carried out in the best possible approach to normality. A few movements in the full range o f a joint may be better than a large number in a restricted range. There are, nevertheless, som e uses o f the hands that may have to be restricted or excluded because they, more than others, tend to encourage de­ formity. Take, for example, ulnar deviation in rheumatoid arthritis, studies o f which have recently been made by Vaino and Oka (1953) and by Baker (1953). In the former article the suggestion is made that this deformity is commoner in women because they go on working whereas men take sick leave. That is a broad generalization which tells only part o f the truth. N o t only do women con­ tinue to work, but many o f their occupations tend to be carried out in a position which encourages the deformity. A particularly important example is knitting, especially if done with the postures and movements used in Great Britain. Y et very many women go on knitting when it is quite unsuitable occupation for them. Another example, affecting both sexes, is walking with the use o f an ordinary crook-handled stick. In cases in which the feet and knees are affected first, it is a matter o f specu­ lation how far the subsequent • evolution in the hands is influenced by grasping a stick, so that much o f the weight o f the body is taken on the hand in that deviated position o f the fingers. The answer to the questions raised can be found only by detailed studies o f posture and m otion, which ought to be undertaken and pursued with vigour and precision. Baker, Frances (1953). Arch. phys. M ed., 34, 299. Vaino, K ., and Oka, M. (1953). Ann. rheum. Dis., 12, 123. Curvature of the Spine In out-patient departments, panel doctors’, waiting-rooms, m others’ meetings or anywhere else where men and wom en gather together and talk, one may hear som e remarkable reported diagnoses. M any o f them rest on misheard medical terms, and probably convey little or nothing to the people who hear or repeat them, but there are two very com m on mis-descriptions, often to be heard from the lips o f people who should know better, and which must imply a total ignor­ ance o f physiology and anatomy. One is that the patient or som e friend is suffering from blood pressure, the other that the affliction is spinal curvature. It would probably surprise som e o f these glib repeaters o f misunderstood phrases to be told that they w ould die in the absence o f the first and be unable to stand or walk without the second. The curvatures o f the spine are, indeed, one o f the marvels o f creation, or rather o f evolution. They begin to be so in animals which still go on four legs. It is one thing for a head the size o f a hen’s or a weasel’s to be supported in advance o f the spine, but when we com e to the relative proportions o f head and back in a lion, a horse or a dog, the wonder grows. In these higher mammals the main curves o f the spine vary— the horse, for example, has much more marked spinal curvatures than has the cow, but if one puts a human being on all fours or makes a dog stand on its hind legs the comparison between the human and the animal spine is easy to make, and the likeness between the shoulder and hip joints and those o f the fore and hind limbs is also con ­ siderable. In the m onkey-house the gradual changes which enabled the upright posture to be attained m ay be studied in series. 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. ) January, 1954. P H Y S I O T H E R A P Y Page Eleven . D id th e . first constructors o f an arch, one wonders, derive the idea, o f laying stones with progressively narrowed bases together from the backbones o f the animals which had been killed for their fo o d ? It is usual to talk about the vertebral colum n, but we might just as well call the spine a series o f four arches, with successive narrowing and broadening o f the anterior and posterior surfaces o f the individual vertebrae and their connecting discs to form them. What wonder is it if, with all the stresses o f growth, o f gradual assum ption o f the erect posture and o f the carrying o f weights additional to that o f the head and body itself, either the curves o f the spine or the join ts o f the spine with the limbs sometimes com e short o f perfection or lose their proper relations during later life? Some spinal defects are congenital (Law, 1953), som e are due *to disease, but m ost are due to postural faults or overloading, and thus are preventable, by proper care o f the infant, the child, the adolescent and the worker in industry. Law, A . (1953). Vertebra] C olum n—Injuries an d D iseases.” In British Encyclopaedia o f M edical Practice, 2nd edition, p . 610. Lo n d o n : B utterw orth. FOR SALE PR IV A T E PR A C T IC E. F o r Sale, S outhern R hodesia—Thriving Private Practice established 1925. A udits available. Big opportunity for energetic Physiotherapist. Two attractive an d fully equip­ ped treatm ent room s an d office situated centre o f town in same buildings as ten other D octors. Owner retiring for dom estic reasons. P art Paym ent considered. A pply: P.O. 11, P h y s i o t h e r a p y D e p t . , G e n e r a l H o s p i t a l , J o h a n n e s b u r g . j * * * F O R SALE. One F arad ic Battery, One G alvanic and Sinusoidal M achine, Two Infra-red Lam ps an d One Short Wave D iatherm y Machine, all portable. A lso One H yfricator. W rite:—P . 012, P h y s i o t h e r a p y D e p a r t m e n t , G e n e r a l H o s p i t a l , J o h a n n e s b u r g , o r ’phone 6 - 4 9 6 7 (C ape Town). * * * * G O O D P H Y S IO T H E R A P Y P R A T IC E F O R S A L E , C A P E TO W N . A v a ila b le M a rc h 1st o r e a rlie r. A ny re a so n a b le offer c o n sid ere d . F o r p a rtic u la rs — w rite : P. 013, P hysio th era pv D epa rtm en t, G eneral H o sp ita l, J o ha n n esbu rg . * * * * PH Y SIO T H E R A PIST urgently required for N ursing H om e in Cape Town. Experienced with chest an d o rth o ­ paedic conditions if possible. Salary approx. £47 p.m . plus free lunch an d tea. A p p l y : — P . 014, P h y s i o t h e r a p y D e p a r t m e n t , G e n e r a l H o s p i t a l , J o h a n n e s b u r g . BOOK REVIEW T h e P r i n c i p l e s o f E x e r c i s e T h e r a p y by M . D ena G ardiner, M .C.S.P., 260 p.p., 193 Figs., Published by G, Bell & Sons, Ltd., Y ork H ouse, Portugal Street, L ondon, W.C.2. Price 21s. net. This is a book which physiotherapists have needed for years. Miss G ardiner is m ost qualified to write a book o f this nature, since she has the Diplom a o f Bedford Physical Training College an d is a Physiotherapy teacher. The principles underlying m ovem ent o f joints and muscles are clearly and fully explained. We are then given detailed techniques for mobilising jo in ts and strength­ ening muscles. A lthough m ost o f the text refers to active exercises, as naturally this forms the largest p a rt o f exercise therapy, the uses o f static muscle w ork and o f passive exercises are explained fully. Every jo in t in the body has specific movem ents described for it, both for m obilizng and strengthening. The text is profusely illustrated with excellent clear diagram s. T he clarity o f the text is striking, and includes a very useful chapter on instruction o f th e patient. This is quite the best o f the very few books published on this im portant subject, and it must be recom m ended not only to students but to physiotherapists and everyone interested in this vital aspect o f o u r work. L.D . L i v i n g W i t h a D i s a b i l i t y by H ow ard A. R usk, M .D . and Eugene J. Tayor, published by The Blakiston Com pany Inc., G arden City, N ew Y ork. Price $3.50. H ow ard A. R usk and Eugene J. Taylor, respectively D irector and A ssistant Professor o f the Institute o f Physical Medicine and R ehabilitation o f the New Y ork University —Bellevue' M edical Centre, have done a great service to all disabled persons by w riting this book. They have collected together inform ation about gadgets and devices for assisting these people in everyday activities so th at they can become as independent as possible. T he book is extremely well illustrated by p h o to g ra p h s, plans and diagram s o f the various devices all with an accom panying description o f them . Some would have to be m ade in O rthopaedic an d H ospital workshops, but others are simple enough to be m ade at home. This is prim arily a book for the disabled person himself, bu t it is an invaluable asset to any physiotherapist, since it is essentially one o f o u r im portant aim s that we help disabled people to become as self sufficient as they can. Included in the book is a very useful chart listing various daily activities whereby one can access a p atien t’s disabilities. I t w ould o f course also act as a useful incentive a n d form o f encouragem ent for the patient to be able to strike out his own particular disabilities as he learns to m aster them. “ Living W ith a D isability” was sent to us by the N ational F o u n d atio n for Infantile Paralysis and we are grateful to the Foundation for introducing to us such a well planned, useful an d attractively produced book. L.D . 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. )