December, 1948
P H Y S I O T H E R A P Y  Page Seven

THE S P A S T IC  C H ILD

By Miss M . C. G R A N T , M.C.S.P., T.N.

Physiotherapist in charge Open-air School for Physical Defectives (not M ental), Durban.

W e have all experienced the complex nature of the 
difficulties met in the treatment of the spastic child.

These little people are perhaps the most pitiful — 
with their ungainly and inco-ordinated movements, 
intense and often unintelligent expressions and un­
happy speech— they appear to be shut out from 
everything which makes life worth while.

People are apt to dismiss them as “dull” (I will 
not dare say mentally defective) because they are 
not able to express themselves lucidly and quickly, 
consequently they are often left on one side. But, 
;is the disability is an interference of the motor 
control over the area involved, which is seen as an 
interference with skills, both basic and subtle — 
rather than poor intelligence, and when we know that 
the child is striving against such grave and almost 
insurmountable odds to get over to others the extent 
of his knowledge and understanding, our aim should 
surely be to meet him half way to help him to over­
come his defects. If the child cannot walk and is 
unable to express himself clearly, he cannot begin 
to live.

Intimate contact with these children has taught 
me that though some are dull, others are of very 
high intelligence. If  helped wisely, they can make a 
contribution to society, which is often an individual 
achievement of the highest order; but if left without 
help they become mere spectators, or worse still, ex­
pensive derelicts.

Unfortunately, diagnosis is not easy in the early 
stages—often no abnormality is detected until about 
the first year of the child’s life. If  parents recognised 
the signs of spasticity at an early age, perhaps babies 
would be brought for treatment earlier. Faulty move­
ments could then be corrected before they became 
established, or made brain tracts. Stiffness could also 
he prevented.

Disabilities range from a mere slowness and in-co­
ordination of movements to flexor contractures of 
different degrees, of either leg and arm, general, 
scissor legs, or. there may be only excessive activity 
°f a purposeless kind with non-intention movements, 
abnormalities of hearing, speech, or eyes (i.e., strabis­
mus or nystagmus) may be present.

Classification is very important in the management 
°* these children. The full extent of the disability 
must first be assessed, then the medium through 
which the disability can best be helped.

. ^ ° se team work is necessary between psychologist,
eacher, speech therapist, physician, orthopaedic and
rain surgeons, physiotherapists, orthopaedic nurse 

and parents.

Splinting is used to control flexor contractures of 
the limbs— if unsupported the elbow and wrist will 
contract and fingers go into the clenched fist position 
with radial deviation. The leg will have tight ham ­
strings— equinus, then eversion and last inversion of 
the foot takes place. The latter position makes walking 
impossible. Stabilisation at this stage (when bones 
have sufficiently formed) has been carried out by the 
orthopaedic surgeon with most gratifying results, 
because it makes walking possible again." The type 
with the scissor legs has also been helped by surgery. 
Brain surgery has been done for the cases complicated 
by fits—with success.

Relaxation is of infinite help. Put the child on his 
back with a small pillow under his head only. W ith  
his eyes closed, instruct him to relax each part of the 
body in turn, until complete relaxation of the entire 
body has occurred. This is best brought about by the 
child mentally speaking to each individpal part. M a in ­
tain this for is minutes. If suitable music is played 
it is easier to hold.

Hydrotherapy is an ideal medium for treatment, 
because by this means a number of things can be 
gained. Fear of the water is first overcome. Later, 
rhythmical movements in the water will assist co­
ordination. Qualities such as independence, self­
esteem, self-preservation, initiative, courage and 
happiness are promoted by his activities in the water. 
The day he can undress, swim, and dress himself 
again is a glorious red-letter day.

The spastic cannot cope with anything small —  
the buttons on his clothes must be large enough for 
him to handle. In  handwork always start with large 
articles, i.e., threading large beads.

First get his confidence and love, then work up 
enthusiasm by m aking all tuition into a game; give 
him a challenge to turn his disability into a stepping 
stone instead of a mill-stone. This is not easy as, if 
too excited, the spastic goes to pieces and if not 
stimulated he becomes a mere spectator. So the 
middle way is the only safe one for him. Remember 
always, the measure of his progress is reflected by 
your interest and encouragement. Stimulation is pro­
vided by praise for his efforts— endless reiteration 
of what you wish him to achieve, until it becomes a 
habit of mind, and confidence is gained. Single him 
out, praise him to his school-mates, praise him to his 
teachers and his parents, and let him know exactly 
how delighted you are with his personal effort and 
magnificent achievement. Then watch his face. The 
exhausting and concentrated effort on your part will 
be amply rewarded.

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