In many cases tim e is the great healer. O th er de­ fence m echanism s include: w ithdraw al, projection, identification, rationalisation. In conclusion, the im portance of a personalised re­ lationship betw een th erap ist and p atien t m u st be stressed. T he physiotherapist m ust un d erstan d th e p e r­ sonality and em otional type o f the p atien t she is treating, thus enabling h er to treat the whole person. 98 A relationship based upon openness, give and take m utual trust and em pathy will help th e paraplegic appreciate his own self worth as a un iq u e h u m an being. In tu itio n and experience are n o t sufficient in un­ derstanding o u r patients fully. A know ledge of psy. chology m ust be an integral p a rt o f th e physiothera­ p ist’s skills. It is therefore essential th a t psychology be included in the education of all physiotherapists. DESEMBER 1981F I S I O T E R A P I E MANAGEMENT OF THE SEVERELY DISABLED R E P O R T O F A S Y M P O S IU M H E L D I N A P R IL 1 9 8 1 A one-day sim posium on the M anagem ent o f the D isabled was arranged by the D ep artm en t of Physio­ therapy, U niversity of C ape Tow n (U.C.T.) in c o n ju n c­ tion with the P ost G raduate M edical C entre, as p a rt of the activities o f the In tern atio n al Y ear fo r the D isabled. D uring the m orning session several professionals gave an outline of th eir respective roles in handling the dis­ abled and a p atien t also put his point o f view. In the afternoon session specific problem s o f a selected n u m ­ ber of disabilities/diseases were discussed. A bstracts or full papers w ere m ade available to all participants (over 80 of all disciplines), and adequate tim e was allowed for discussion. P rofessor G eorge W aterm eyer of th e D epartm ent of C om m unity H ealth, U .C .T ., set the scene by dis­ cussing the Philosophy o f Rehabilitation in 1981 and stated that reh ab ilitatio n is a concept whose m eaning varies from the precise to the vague, according to individual taste, practice and experience. Q uoting A. M air, traditionally reh ab ilitatio n was restricted to phy­ sical m ethods applied to local parts of the organism , designed to im prove function and alleviate sym ptom s. T his had to be re-defined since the definition of the healthy state has becom e much wider and now en­ com passes a state of positive physical, psychological and social well-being. M any attem pts, however, have become bound by the discipline they represent and end up with M air’s definition. M ore note should be taken of m ental and social factors which m ay be m ore crippling than the obvious physical com ponent, w hilst cultural and environm ental factors, totally am enable to correction, may com pound a disability and enhance dependence. H e cited the 'exam ple of the am putee, “ fully reh ab ilitated ” , th a t is discharged hom e and then becom es hom ebound, isolated and depressed because a sandy sidewalk prevents him from getting his w heel-chair out o f the house; sim i­ larly, disrupted fam ily relationships, cross-cultural con­ straints and o th e r social issues m ay m odify the o u t­ come of an otherw ise w ell-intentioned and carefully designed rehabilitation program m e. T he process of re­ habilitation does no t have a certain starting p oint and an end point in the course of disease/disability; how­ ever, periods o f optim al intervention and tim es of m axim um effect m ust be identified and utilised m axi­ mally for each individual circum stance. R ehabilitation goals should be realistic both for the p atien t and the therapist and sufficient time devoted to the assess­ m ent of progress. E voking false hopes an d expectations often result in a loss of confidence an d com pliance, thus it is im p o rtan t to state an acceptable goal and adhere to it. A ssessm ent of the residual ability should not only be o f physical and m ental capability, but include the fam ily, social, cultural and com m unity resource potentials. A ctive rehabilitation, be it com plex and m ulti­ faceted, occupies a relatively short period and then the real problem s start. Long-term support of the disabled in the com m unity is essential. T he concept of “ alleviate c are” put forw ard by A bel-Sm ith, namely th at a com m unity health care facility can care for the chronically iil within the com m unity and that^ facilities can be m obilised in the com m unity to heljjf ease the burden of the care required by disabled at hom e, seem s ideal. It w ould thus seem th at the responsibility fo r rehabilitation and after-care of the chronically ill/d isab led should be accepted by both health professionals and the com m unity alike and we w ould be nearer to the ideal or broad definitation as stated by M air. In South A frica the acceptance of the concept o f rehabilitation by professional bodies has been slow, fragm ented and unco-ordinated but the H ealth A ct of 1977 has laid the ground rules for a total strategy which aims at a com prehensive, m ulti­ disciplinary approach to long-term care of persons w ith chronic disability. Miss Ida Bromely, Superintendent Physiotherapist of the Royal Free H ospital and D istrict P hysiotherapist of C am den, as well as C hairm an of the Council of the C.S.P., addressed herself to the role o f the phy­ siotherapist and titled her paper “Observation + A ction = Prevention”. A trial docum ent, the International Classification o f Im p a irm en t D isabili­ ties and H andicaps, published by the W orld H ealth O rganization in 1980 w ith the sub-title A M anual of C lassification R elating to the C onsequences of Disease, attem pts to give guidelines to assess and classify dis­ ab lem ent so th a t inform ation can be gathered on a sound basis and a b etter understanding of the pro­ blem s can be obtained. In developed countries c h r o n ic illness and m edical responses to it occupy a d o m in a n t position and m ore atten tio n needs to be focussed on the disabling and handicapping consequences of disease rath er than the pathology. She w ent on to define com­ m on term s; im pairm ent is any loss or abnorm ality of psychological, physiological or anatom ical structure or function; disability is any restriction o r lack (resulting from an im pairm ent) of ability to perform an activity in the m anner or w ithin the range considered norm al for hum an beings; handicap is a disadvantage fo r a given individual, resulting from an im pairm ent o r disability, th a t limits or prevents the fulfilm ent of a role that is norm al (depending on age, sex, social and cultural factors) for th at individual. H andicap thus occurs when there is interference with the ability to sustain what m ight be described as “ survival roles” . D escribing the consequences of disease m ore accurately and cate­ gorically will clarify the issues and give less offence through inadvertent stigm atising of people who have disabilities o r handicaps. She cited the exam ple from the N orw egian poet Bekke: “ 1 used to be M rs. Lind with a stiff hip. Now 1 am a stiff hip called Mrs. L in d .” H an d icap o r disadvantage if >ulting from a p a tie n t’s im pairm ent may be increased through in- 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. ) DECEMBER 1981 P H Y S I O T H E R A P Y 99 ■ Hequac*es health care, such as inappropriate or in­ e x p e r i e n c e d care which often occurs when m any patients already carry an intolerable load. F inancial restrictions are present in all econom ies, but it was th o u g h t that r e s o u r c e s are no t m arshalled to t h e best advantage to • li d the severely disabled patient. R ehabilitation can b e d e s c r i b e d as an attitu d e and the rehabilitation team ,1S a team of “ enablers” seeking to help the p atient to help himself, teaching him ways of coping with his disabilities in o rder to reduce his handicap to a m i n i m u m . Successful rehabilitation depends on a high level dynamic, not custodial, care. T he physiotherapist assists the p atien t to achieve m axim um physical in ­ d e p e n d e n c e w ithin the restrictions im posed b y the im ­ pairment and in preventing fu rth er disability an d h a n ­ dicap. All m em bers of the team need to be realistic and honest with the p atien t ab o u t his potential and lim i­ tations, prepare him for w hat lies ahead and prevent c o m p l i c a t i o n s i f possible. O bservation + action can mean prevention. Patients with severe im pairm ent and disability m ay gain independence only by m echanical m eans and yet Wiese patients have m arried, w ritten books and con­ tributed to society. T his life style depends on a high level of skill in the rehabilitation team , good m o ti­ vation in the p atient and a presupposed freedom from complications. T h ere needs to be a system whereby the severely disabled p atien t can be screened regu­ larly by the physiotherapist, as fu rth er disability can have small beginnings. T he physiotherapist then needs to have an “ at risk register” of patients who need close and constant observation. T his m ay be easier if there is freedom to cross the boundary betw een hos­ pital and hom e o r w orking solely in the p a tie n ts’ homes or to have a general practitioner referral system O the hospital physiotherapy departm ent. T his will en­ tail regular full exam ination and assessm ent of patients in all appropriate situations and activities. She then went on to cite som e of the m ajo r contributing p re ­ disposing factors, such as bed sores, m uscle im balance, spasticity, contractures apd increased reflex activity. The young patient, still growing, presents p articu lar pro­ blems a t times when there is a growth spurt. R econfine- inent to bed could be dangerous fo r som e patients. A lotal survey of the p a tie n t’s daily activities, age and adaptations used, w heel-chair and calipers needs to be made. D iscussion with the p atien t may be sufficient, as once he is aw are of the consequences, he will follow advice given. R elatives or care atten d an ts need in ­ stru ctio n in a p p ro p riate m easures for positioning in TDed, adjustm ent to the w heel-chair or o ther equipm ent. An intensive sh o rt course of physiotherapy m ay be necessary if there are problem s, the p atien t will move up the at risk scale and will need to be exam ined more frequently for a while. Richard Brusser, a lecturer a t U .C.T. and him self a paraplegic, spoke ab o u t the Psychological Problems and Needs o f the Paraplegic Patient. H e based his comments on his own personal experience and those of his friends and fellow patients >with w hom he spent several m onths in hospital. H e felt th a t medical schools turned out a large num ber of persons trained ex trem e­ ly well in the various fields of m edicine such as doc­ tors and physiotherapists. T hey are superb technicians with an excellent know ledge of physical m edicine but lacking in sim ple hum anity. H e discussed th e p a tie n t’s psychological problem s and needs in two stages, nam ely when he first arrives in hospital a fte r his accident and when he first gets out of bed and into his w heel­ chair. On arrival in hospital, particularly afte r an accident, the p atien t is overw helm ed by pain and total bewilderment. H e realises som ething m ajor has h ap ­ pened but does no t understand the natu re of it. H e looks to the m edical staff (doctors, nurses, physio­ therapists) fo r psychological sup p o rt an d he strongly felt th a t they should explain the condition to the patient and give som e sort of prognosis, although he realised th at at this time an accurate prognosis was not possible. H e le lt th a t patients w ere considered m orons, or incapable of handling the tru th and th at the u n certain ty w ith which he was left, was the single m ost frustrating and depressing factor. H e felt th a t there should be no stan d ard policy on inform ing patients, b ut th at each p atient should be treated as an indivi­ dual'. H e felt patients could be better prepared psy­ chologically for the physical handicaps they are going to have to face. In discussion later on it was pointed o ut th a t patients often do not “ h ear” w hat the doc­ tors o r o th er health professionals tell them because they are n o t yet ready to receive the inform ation. M r. B russer then described the next stage, when the p atien t first gets out of bed and in to his w heel­ chair. T he p atien t is confronted w ith the enorm ous physical problem s of m ovem ent with which he will have to contend fo r the rest of his life and at this stage these problem s are m ore acute due to his ex­ trem e w eakness from lying prone fo r three m onths. T he m ajor psychological problem a t this stage is a general feeling of uselessness and fear of no t being able to cope physically and socially u n d er the new circum stances. The feeling of uselessness arises from the inability to move from one point to another, poor balance and incontinence, as well as re-evaluation of personal relationships in term s of w hat the p atient can offer others and th at he is only going to be a burden to all. This feeling of uselessness is com ­ pounded by the te a r of the unknow n outside the hos­ pital w here there arc a m yriad of physical and psycho­ logical obstacles. A t this physical and psychological crisis stage th e physiotherapist can act as the key to the future. H e felt that the physiotherapist coped very well w ith the physical crisis but n o t so well with the psychological crisis. H e once m ore appealed th at all p atients should be approached as individuals and th a t no “standard treatm en t tech n iq u e” should be a p ­ plied to all patients regardless. H e felt th a t physiothera­ pists should receive m ore training in the psychological aspects o f dealing w ith patients such as paraplegics. H e felt this to be very im portant as the physiotherapist is such a key person in the treatm en t team . Miss C hrista M eyer of the D ep artm en t of O ccupa­ tional T herapy a t U.C.T. d ealt w ith Sport and R e­ creation for ths Severely Disabled. She stated th a t it is im p o rtan t to d ifferen tiate betw een sport and recreation in o rder to u n derstand th at the disabled need both. U .N.E.S.C.O. defines sport as any activity w hich has the character of play which involves a struggle w ith oneself or others or a co n fro n tatio n w ith n atural ele­ m ents, while C a n to r and W ertham define recreation as all those things which m an does and those artefacts he creates fo r th eir own sake, or th at diverts the mind and body from the sad business of life . . . it is m an in pursuit of pleasure, excitem ent, beauty and fulfill­ m ent. She then defined a severely disabled person as one who has suffered physical o r psychological traum a of such a n atu re or extent th at he is n o t capable of effectively carrying out activities related to daily living. In all cases a com m on problem is faced, namely, th at ol particip atio n in life. S port and recreation have num erous physical, psychological and social attributes th at have overcom e this problem and the occupational therapist uses them as special therapeutic tool to al­ leviate the results of pathology; to m ain tain physical, psychological and social aspects o f function retained; to com pensate or substitute for loss of function. Sport and recreational activities are graded in term s of time, 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. ) 100 F I S I O T E R A P I E DESEMBER 1981 endurance and e ffo rt/d e m a n d s in o rder to m eet the individual at his level of participation and to answ er his specific needs. Personal involvem ent on the p a rt of the th e ra ­ pist and a suitable m ethod of presentation will cap ­ ture the p a tie n t’s interest and co-operation and elicit m axim um participation and attention. N orm ality ol the activity and treatm en t situation is enhanced by the correct th erap eu tic atm osphere, w earing suitable clothing, having the necessary equipm ent available, a sound know ledge of instruction m ethods, rules and regulations, as well as good planning and preparation to prevent confusion and resu ltan t loss of enthusiasm . M o d ific a tio n /a d a p tio n of rules, m aterials o r tools may be necessary to enhance fun and enjoym ent to give satisfaction fro m participating and to accom plish the activity m ore easily. A ccurate physical, psychological, social and functional assessm ent o f the disabled will determ ine the m ethod em ployed by the occupational th erap ist fo r grading, presentation, structure, m odifi­ cation and ad ap ta tio n of the activity as well as the h andling o f the person. The disabled should be in ­ volved in planning th e sp o rts/re c re a tio n program m e so as to allow him th e privilege of m aking his own deci­ sions and feeling p a rt o f the program m e. In this way the occupational therapist uses the pleasurable activity of sport and recreation and function derived from them to reintegrate th e p atien t into his total life p attern , nam ely work, social and personal life scales. Miss E lsabe B urger highlighted som e interesting aspects o f the R ole o f the Social Worker in the m an ­ agem ent of the severely disabled, aim ed a t returning the disabled to the com m unity, functioning to th e ir full potential. T his requires liaison betw een w elfare based services and th e rehabilitation team in o rd er to assess, mobilise and develop resources within the com m unity to support the disabled to achieve active participation w ithin the com m unity. She focussed on accom m odation as the living environm ent which will determ ine the level of independence th a t can be achieved. Very few are in a position to build a hom e to th eir specification and m ost frequently alteratio n and ad ju stm en t of exist­ ing homes w ould be m ore realistic. T he disabled person and his fam ily should be aw are o f literature giving inform ation about, and be encouraged to bring about these changes. T he em phasis recently has been on returning the disabled to th e com m unity, but it is felt th a t various options of living arrangem ents should be open to disabled persons. C heshire H om es o ffer a form of com m unal accom m odation w here assistance w ith daily care is available, as well as participation in the daily affairs and socialisation an d yet affording a degree of privacy. Sm aller houses, accom m odating 8 o r 9 persons, run and m anaged by the residents them selves, have also been started. Focus F lats in Sweden contain a certain percentage of individual flats, in a large block, reserved fo r the disabled and spe­ cially adapted w ith extensive su p p o rt systems such as care atten d an ts, com m unication systems, com m unal room s and tran sp o rt facilities enabling the severely disabled to live am ongst non-disabled persons, thus running th eir own hom es w ith adequate aid and sup­ port. Ten T en Sinclair, a schem e developed in C anada, assists young adults in gaining residential living ex­ perience, developing m axim um physical independence, acquiring personal and hom e-m aking m anagem ent skills, experiencing confidence in total com m unity in­ tegration and developing m eaningful vocational and leisure tim e activities. T he possibility of a sim ilar schem e, in C ape T ow n, of individual living units a t­ tached to the su p p o rt system of the C heshire H om es is being explored. T he availability o f regular, sym pa­ thetic and ad eq u ate a tte n d a n t care is a m ajor require­ m ent for secure an d independent integration into the com m unity. T his often falls to close relatives, placing inevitable and considerable strain on the disabled and his fam ily, often ending with institutionalisation where care is guaranteed. T here is a pressing need to de­ velop a tte n d a n t care services and su p p o rt in the com m unity. L inked with providing a tte n d a n t care should be a facility enabling both the fam ily /carers and the disabled to have holidays w hich can be of enorm ous value to the disabled and a t the sam e time bring relief and respite to the care r/fa m ily . M echanical aids can be of g reat value and assistance, b u t there is a lack of inform ation and a p erm an en t display o f a com prehensive range o f aids is essential. T he com m unity needs to develop support systems which will enable the the disabled to m ove outside th e hom e and fam ily and develop new interests and activities. To establish m ean­ ingful em ploym ent opportunities, extensive back-up services are required; effective approach by professionals well versed in the abilities and lim itations of the per­ son needing em ploym ent, and em ployers’ previous ex­ perience in em ploying the disabled all play an im ­ p o rta n t part. W here full-tim e em ploym ent is not pos* sible, hom e industries have provided the satisfaction^ stim ulation, sense of achievem ent and socialisation which are all aspects of “ w ork” . This type o f activity can be introduced during h o sp italisatio n /reh ab ilitatio n and continue on retu rn to the com m unity. Finally, the problem w ith architectural barriers were m entioned and the form ation o f an Access C om m ittee, comprising several severely disabled persons, to look at this p ro ­ blem . A disability register is being com piled in order to assess the ex ten t of the problem . M rs. Joy M iles gave her personal views on R ehabili­ tative Aspects of Community Nursing and felt the stru c­ tu re o f existing services need n o t change, but th a t a closer liaison betw een hospital, local au th o rity and w elfare services was necessary. U nderstanding of goals, roles and procedures of each betw een m em bers o f the m ultidisciplinary team will im prove inter-personal rela­ tionships and effectiveness. She gave the W .H .O. defini­ tion o f “organised com m unity nursing usually outside the hospital, providing com prehensive nursing care to indivi­ duals, fa m ilies or groups, w ith th e m ajo r emphasisi on the prom otion o f health, prev en tio n of disease an d reh ab ili­ ta tio n ” . T he com m unity nurse has know ledge of the various N atio n al C ouncils and voluntary organisations, skill in assessm ent (physical, social and em otional) and h er approach is fam ily centred, assisting the fam ily to m eet health needs by using th eir own resources and available h ealth services. T he first intensive phase c§ rehabilitation begins in hospital a t the tim e of d iag n o s^ and w ith the trend tow ards early retu rn to the h o m e / com m unity, the com m unity nurse can act as liaison betw een the hospital-based rehabilitation team and h o m e/co m m u n ity , by assessing th e physical and psycho­ social environm ent th e p atient will be returning to and suggesting/im plem enting aid s /a d a p ta tio n s. She can p ro ­ vide continuity o f care and support, m o n ito r progress and problem s, ensure m axim um and balanced function of p atien t and fam ily, and liaise betw een hospital, o th er services, com m unity and patient. She could rein ­ force and encourage co m m itm ent to long term therapy, supervise drug regime and educate the p atien t and fam ily in therapy routine. All this should ensure lessening o f the stress on the p atien t and his fam ily, enabling him to integrate and function in the fam ily and com m unity to his m axim um capability. P rofessor Kay de Villiers opened the afternoon ses­ sion by expanding on the Meaning o f Neurological Illness. P atients consult a neurologist or neurosurgeon for the sam e reasons which take them to any o th er doctor, nam ely pain, fear and anxiety; often they have no choice as they have already been rendered uncon­ scious by a catastrophe. T he p atien t expects, and re­ 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. ) DECEMBER 1981 P H Y S I O T H E R A P Y 101 ceives, a diagnosis and treatm ent. T he diagnosis will unintentionally accentuate his defects ra th e r than his abilities and can hold disastrous im plications, since labels, such as paraplegia, hem iplegia o r epilepsy will require painful physical, psychological and social ad ju st­ ment. D iagnosis can bring relief with the realisation that the disease is organic and self-esteem can be restored despite the fact th a t it m ay im pose a sentence such as a restricted life o r a lim ited lifespan. F o r a small group it may even be a way out and rejection o f the realities of life. Im plications for the relative of the neurologically affected patient m ay vary from a change in life style, altered financial circum stances, and guilt, which can be particularly devastating in the case of parents whose child has a h ered itary neurological condition. R eaction to the diagnosis can vary from rejection, w ith the patient consulting different d o cto rs/in stitu tio n s in the hope of a cure, to depression or anger against those closest to him. E uphoria o r negativism may be a feature o f the disease itself and not necessarily the p a tie n t’s reaction. The unconscious p atien t aw akes to a new reality, often con- jfused and w ith im paired mem ory, being cared fo r by strangers in a strange environm ent, w hilst realisation of his situation m ay (or m ay not) slowly daw n on him , all of which increase the psychological pain fo r him self and his fam ily. H e is faced w ith the loss of independence, of working and earning capacity, and of m obility, leading ta loss of self-esteem and confidence. An aw kw ard gait, for instance, m akes him th e object of unw elcom e a tte n ­ tion and horizons are narrow ed whilst pleasure comes from small things such as the ability to walk unaided. He becomes aw are of the proxim ity of death and a new look a t life may be necessary. In o rd er to rehabilitate the patient, the despair and depression m ust be u n d er­ stood, and a ttain ab le goals m ust be set to help him overcom e this. Clinical defect should not be equated with disability since a m in o r stroke can be totally dis­ abling fo r one and a m ajo r stroke can n o t hold back an o th er person. With a sound personality, correct environm ent and an intact intellectual capacity, m any people can becom e new and g reater individuals than before, and therapists m ust give each person the chance to attain this. Dr. P a t K lem p (D ep artm en t of R heum atology, U.C.T.) in dealing w ith the Problems and the Patient with Rheumatoid Arthritis, underlined the despair of most of these patients by stating th a t although rh eu m a­ toid arthritis (R.A.) does not kill, it m ay m ake the patient wish he was dead; during the productive years the p atien t’s body will disintegrate into uselessness and ie will suffer great frustration. H e quoted statistics for the U.S.A. and U.K., to dem onstrate the m ajor socio­ economic im plications o f R.A. H e d ealt with the specific problems facing the p atien t u n d er a num ber o f headings. Physical problem s during the acute phase will be th at inflam mation o f synovial joints leads to pain and stiff­ ness, as well as constitutional sym ptom s such as fatigue and weight loss all of which often confines the p atien t to bed at hom e o r in hospital, interrupting norm al activi­ ties and w'ork regularly over a period o f m any years. In the chronic stage the p a tie n t usually has a n u m b er of joint deform ities, often im posing severe lim itation on his life style. T here will be interference w ith activities of daily living and m obility, whilst sport and recreation is curtailed by problem s of access to public buildings, leading to isolation of the patient. E x tra-articu lar m an i­ festations can lead to progressive respiratory im pair­ m ent or blindness, whilst the rare “ m alig n an t” R .A . is associated w ith a high m ortality. Sexual dysfunction due to pain and lim ited m obility, as well as depression, the feeling o f being sexually undesirable and c o n stitu ­ tional sym ptom s, m ay be a m ajo r problem . T reatm en t itself m ay cause problem s, in th a t the p atien t is usually on life-long m edication and polypharm acy has side effects th a t vary from trivial to lethal. O rthopaedic rheum atology has m ade great strides b u t often necessi­ tates m ultiple procedures and the subsequent reh ab ilita­ tion taxes the p atien t physically as well as m entally. E m ploym ent is a very real problem as flare-ups in ter­ rupt work, and progressive disability lim it the possibili­ ties. M ost patients are forced to resort to a disability g ran t which increases their financial and psychological dependence. D epression can be a prim ary feature o f the disease but often is secondary to the num erous problem s already m entioned. T he cause o f R.A. is unknow n, but early aggressive m edical therapy and a p p ro p riate surgical intervention can reduce or even prevent disability and both the m edical profession and the public need to be educated to this effect. An effective m ulti-disciplinary reh ab ilitatio n team go a long way to alleviate the p a tie n t’s problem s b u t a g reat deal still needs to be done in this respect. Dr. Brookes H eyw ood of the D ep artm en t of O rth o ­ paedic Surgery, U .C.T. said th at The Major Orthopaedic Disabilities will interfere with m an ’s ability to stand up straight, to walk, and to use his hands, an d could be due to m any genetic and environm ental diseases. The im pact varies with the age o f the p atien t and the n atu re of the pathology. T he very young child stricken with paralytic poliom yelitis will never know independence nor achieve it, despite rehabilitation, aids, or surgery; a t some stage he will realise how poorly endow ed he is. A n intelligent vigorous young m an m ay be rendered paraplegic in an accident and lose all th at has been. F o rtu n ately m an ’s spirit enables him to find a new m eaning in life w ithin the confines o f a narrow ed existence, guided by a reha­ bilitation team . D ifferent again is the experiences o f the average m iddle-aged arth ritis p atien t who m ay have had a norm al childhood, adolescence and young adult-hood; early on he can com pensate f o r the pain and stiffness, bu t sooner o r later function is lost, jobs have to be given up and dependence increases. H ow ever, m an has an astonishing capacity to a d a p t and the p atien t com ­ bines with the rehabilitation team to fight the disease. T here has been great surgical advance in this field and fo r instance total jo in t replacem ent is extrem ely cost- effective, particularly when it enables the p atien t to con­ tinue working. In orthopaedics the accent is not on the preservation of life, nor on m aking death m ore bearable, but on im proving the quality of life. D r. H eyw ood also touched on the lack o f em ploym ent opportunities, arch i­ tectural barriers, poor com m unity support and lack of planning to provide facilities fo r the severely disabled. H e feels the disabled often overcom e th eir physical disabilities by a sense o f dedication and resolution which enables them to -e x c e ll in th eir callings and become superior citizens. A full social responsibility fo r these individuals is long overdue in South A frica. The Problems Facing the Handicapped Child usually stem from tw o sources, nam ely the fact th a t they n o r­ mally progress rapidly through a series of developm en­ tal stages and the trem endous dependence the child has on his physical and social environm ent. D r. Chris M olteno of Red Cross C h ild ren ’s H ospital went on to explain th at developm ent can be defined as a progressive series o f changes in an orderly coherent p attern , each new skill depending on preceding changes. As all changes fit in to a global p attern , interference with one set o f changes influences the total developm ental pic­ ture. T hus handicap in one area could interfere with e th e r developing skills, leaving one to distinguish betw een prim ary and secondary o r reversible handicap H e cited the exam ple o f a cerebral palsied child with a reversible perceptual disability which related to body image. His draw ings of a m an rapidly im proved when he received therapy incorporating tactile, kinesthetic, 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. ) 102 F I S I O T E R A P I E DESEMBER 1981 visual and verbal cues. E arly diagnosis and intensive and com prehensive therapy will reduce th e frequency of perceptual and conceptual disabilities in children from low er socio-econom ic backgrounds. A m ore obvious exam ple of a secondary h andicap is the m o to r delay experienced by a blind child, due to in ad eq u ate visual cues and feed-back despite norm al m o to r ability. T he influence of th e m other-child or caregiver-child in te r­ action on early developm ent is significant. P iaget de­ scribes the way th e child elicits responses from the m o th er and vice versa, very well in th e developm ent of im itation in infancy. If the child cannot respond ad e­ q uately because of his h andicap or the m o th er because of th e lack of m otivation due to a failu re o f bonding, the child’s developm ent will suffer. T h e attitudes of fathers is also im p o rtan t as was dem onstrated by a com ­ p arison betw een m arasm ic children and th eir well- nourished younger siblings. A fa th e r w hose handicapped child does n o t live up to his expectations, m ay lose interest in the child and n o t supply th e m uch needed p atern al stim ulation. P aren ts of handicapped children react by dem onstrating shock, guilt, revulsion, in ad e­ quacy and em barrassm ent w hich could cause w ithdraw al fro m social contacts, as well as going thro u g h the stages of bereavem ent at the loss o f the n orm al child they expected. T hey can show anger, expressed in aggressive behaviour; grief, giving rise to depression and finally adjustm ent. U n fo rtu n ately h ealth professionals often also have negative feelings and show negative behaviour w hich only add to th e problem s of th e handicapped child. All children need a stable an d loving social- affective environm ent, b u t handicapped children will require this m ore as th eir parents are usually expected to carry out a com plicated neurodevelopm ental p ro ­ gram m e u n d er th e guidance o f a therapist. Only those p aren ts in th e final stage of ad ju stm en t will be able to do this adequately. A dverse p aren tal attitu d es could include rejection, abuse or over-protection. In addition discipline m ay be lacking so th a t social developm ent will also suffer. H e stressed the need fo r assessm ent of strength and weakness, being aw are of p o ten tial p ro b ­ lems and th a t the aim should be to allow each child to achieve his optim al developm ental level, even though this m ay be com prom ised. D r. H arold H ech t concluded the a ftern o o n by ex­ plaining th at G eriatrics is an Exercise in M ultiple P athology. Since old age is frequently characterised by th e presence of m ultiple pathologies, disability often reflects a com bination and interaction of several m inor and m ajo r handicaps. T hus m anagem ent o f the elderly disabled needs to be based on a thorough evaluation of th e physical, psychiatric and social factors involved. In terv en tio n requires a problem -orientated ap proach as it is usually im practicable, im possible o r unnecessary to tackle all the p resenting problem s. D isabilities should be w eighted according to th eir severity, im portance to the^ individual and their p otential fo r correction. Once full assessm ent has been m ade, m anagem ent can be- planned and tailo red according to individual needs. In terv en tio n at one p articu lar level can affect other levels of functioning both positively and adversely; for instance the treatm en t of hypertension can aggravate depression, w hereas im provem ent in eyesight can reduce confusion. Iatrogenic illness is com m on in the elderly, m ainly due to altered pharm acokinetics an d often due to polypharm acy practised by different specialist disci­ plines. A co-ordinated and m ulti-disciplinary approach is th e key to optim um health care fo r th e aged and the m ost im p o rtan t role of a g eriatrician w ould be th a t of assessor and co-ordinator of a tre a tm e n t plan. REPORT OF THE NINTH MEETING OF THE NATIONAL COMMITTEE OF REPRESENTATIVES WHICH WAS HELD ON SATURDAY 26 SEPTEMBER 1981 IN JOHANNESBURG N A T IO N A L E X E C U T IV E C O M M IT T E E T h e C hairm an, M rs. M athias, w elcom ed th e delegates an d convened th e m eeting. She rep o rted on th e activities of the new N atio n al E xecutive C om m ittee elected in M arch, w hich has h a d fo u r m eetings to date. T he standing com m ittees as well as sub-com m ittees an d ad hoc com m ittees have b een convened and chairm en appointed. T h e industrial, investigating and m edical referral subcom m ittees have been disbanded. T h e a lteratio n o f exam ination results a t the P re to ria College was discussed at the C ouncil m eeting held in A pril an d an E m ergency C ouncil M eeting held in June, 1981. A ro u n d tab le discussion w ith representatives of th e involved institutions was requested and this request has gone b o th to the P rofessional B oard an d the S.A .M .D .C . It has been suggested th a t post-registration courses in In d u stria l/O c c u p a tio n a l P hysiotherapy, th e R eh ab ilita­ tio n of A d u lt H em iplegia and E xercise T herapy be investigated and various overseas lecturers have been approached in this regard. T h e N .E .C . has been actively involved in various aspects of th e career an d salary stru ctu re of th e p ro ­ fession. A com prehensive m em orandum on all aspects of th e profession was subm itted to th e C om m ission of E n q u iry in to h e a lth service u n d er th e chairm anship of M r. B row ne; th e evaluation of th e profession o f physio­ therapy by th e C om m ission o f th e A d m in istratio n was in progress an d com m ents fro m th e representatives in the various provinces will be collated by M rs. van der W att; a sub-com m ittee h ad been app o in ted to investigate the situ atio n of physiotherapists w orking in special schools; a m em o randum was subm itted to th e H u m a n Sciences R esearch C ouncil dealing w ith th e role o f th e physio­ therapist in ed u catio n and as an ed u cato r in general. W hen it becam e know n th a t a proposed bill to provide fo r th e p ractice of the professions of ch iro p racto r^ hom eopathy, n eu ro p ath y an d h erb alist w as once agami}. before P arliam en t, a m em orandum was com piled a m j- an interview sought w ith the M inister o f H ealth ; the su p p o rt of the M .A .S.A . and the S.A. O rthopaedic A sso­ ciation was requested and received, but th e N .E.C . was inform ed by th e M inister th a t th e bill w ould no longer be discussed during th e present session an d an interview a t this stage w ould be unnecessary. T h e d ra ft constitu­ tions of th e S.A. A ssociation of Sports M edicine was approved an d a m em orandum on the ro le of physio­ th erap y in the re h ab ilitatio n o f physical disorders, jn relatio n to th e ro le of th e physical ed u catio n alist in reh ab ilitatio n of physical disorders, was subm itted to Col. E . H ugo. A ustralia, th e USA, C anada, Israel, B ritain, G erm any, H o llan d an d N ew Z ealan d were ap p ro ach ed ab o u t th e possibility o f instituting a n ex­ change system for physiotherapists an d thus fa r only the U SA had answ ered (see notices e :sew here in the Journal). T he D ep artm en t o f H e a lth h ad been approached to m ake posts o f D istrict Physiotherapy w orthw hile to th e incum bent expected to deliver the service in th e com m unity. T he N .E .C . considered a suggestions p u t forw ard at C ouncil as to the roie the Society w ould play in co-ordinating and encouraging research in th e profession an d as a resu lt a sub-com ­ 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. ) DECEMBER 1981 m ittee has been convened u n d er th e ch airm anship of Mrs. J. B eenhakker (see notice elsewhere in Journal). Several m em bers of th e Society have h ad their papers for th e C ongress of the W orld C o nfederation fo r P hysi­ cal T herapy pro visionally accepted an d M rs. K . M. Levy and M r. J. J. Craig have been proposed as h o n orary m em bers of th e 1982 Congress. In discussing m atters arising from th e ch airm an ’s rep o rt it ap peared th a t th e S.O.F.S. B ranch h a d con­ sidered asking M iss P . D avies to d irect a course on H em iplegia at the congress in 1983 a n d th a t Miss M cP hee (in d u strial/o ccu p atio n al physiotherapist in A ustralia) h ad accepted an invitation to visit South A frica b u t th a t her dates w ere still u n certain . I t was also suggested th a t th e Jo in t Services R e h ab ilitatio n M edical U nit in the U .K . b e approached fo r suggestions of courses/ speakers on exercise th erap y as th e physical educationalists are becom ing m ore an d m ore involved in this field. T h e outcom e o f th e C om m ission of E n quiry into the H ealth Services is aw aited. M em bers reported on th e evaluation of th e profession of p h ysiotherapy by | the Com m ission of th e A dm inistration fro m various centres. It ap p eared th a t they w ere sym pathetic, had w orked from a com prehensive q uestionnaire an d had interview ed staff p articu larly as regards provincial condi­ tions of service and salary scales. I t was rep o rted th at there w ould be p arity of all salary scales from A pril 1982. N ew in fo rm atio n could be subm itted until D ecem ­ ber 4th and N .E .C . w ould ensure th a t all m em oranda be subm itted. I t was suggested th a t salary scales be linked to th e inflation rate, th a t a reasonable starting salary be established an d th a t physiotherapists working in hospitals th a t are sh o rt of staff, as w ell as those in private practice and in train in g centres, be interview ed. PROFESSIONAL B O A RD M rs. Levy, C hairm an of the P rofessional B oard for Physiotherapy, rep o rted on th e two m eetings th a t have been held since th e last m eeting of th e N .C .R . A t 30th June 1981 th ere w ere only 1 881 registered ph y sio th era­ pists, as m any have been erased thro u g h failu re to pay their fees or to no tify th eir change of address. G u id e­ lines fo r the accep tan ce o f qualifications in physio­ therapy fo r registration purposes h ad n o t yet been finalised by the L ecturers G ro u p an d th e R egistration C om m ittee, and it is proving a very difficult task as certain registerable qualifications at th e presen t tim e m ay well be affected. Inspections of th e final year exam inations of the U niversity of the O range F re e State and the U niversity of D urban-W estville will take place at the end o f 1981. It is hoped that the train in g a t the P retoria College fo r P hysiotherapy will be changed to the U niversity o f P re to ria by 1982 (this has since been confirmed). T he request by th e Society to investigate the circum stances surrounding th e granting o f a diplom a by the D ep artm en t of N atio n al E d u catio n to a student alleged to have failed th e final year exam ination had been forw arded to th e M edical C ouncil fo r considera­ tion. A pplications fo r registration received from A ustria, Belgium, F ran ce, In d ia and th e U.S.A. h av e b een fo r­ w arded to the registration com m ittee T he final exam ina­ tion to register persons practising physiotherapy, b u t not holding a registerable qualification, was held on th e 7th Septem ber 1981. It appears th a t physiotherapy assistants will be placed on a supplem entary register u n d er th e ju risd ictio n o f the M edical C ouncil and un d er th e u m b rella of the P ro ­ fessional B oard. T h e D e p a rtm e n t of H ealth , W elfare and Pensions wishes to discuss the ro le of physiotherapy in the field of psychiatry w ith an ad hoc com m ittee of th e M edical C ouncil an d th e Society, and this will b e p u t to the C ouncil in O ctober. T h e com m ents of th e P ro ­ fessional B oard for O ccupational T herapy on th e overlap betw een the professions o f p h ysiotherapy an d occupa­ tional th erap y is aw aited, b u t it appears th a t it m ay well be a question of sem antics. A ll physiotherapists were requested to study th e letter sen t w ith th e acco u n t for th e an n u al fee asking them to ensure th a t they are em ployed by a n approved organisation o r institution. If they are in doubt th ey could w rite them selves or ask their em ployer to w rite to th e R egistrar, S.A .M .D .C . P.O. B ox 205, P reto ria, 0001. T h e acceptance of in tro d u cto ry circulars distributed by physiotherapists, will necessitate an am en d m en t to R ule 1 (b) of the rules by w hich registered physiotherapists are governed. W hen the suggested am endm ent is accepted by th e M edical C ouncil an d prom ulgated, th e society should give con­ sideration to the am endm ent o f its ow n ethical rules. A delegation from th e Professional B oard discussed the ad m in istratio n of drugs by physiotherapists w ith the M edicines C ontrol C ouncil b u t no com m ent h ad been received as yet. T he M inister o f H ealth has referred the re p o rt subm itted to h im by th e M edical C ouncil, con­ cerning th e increase in physiotherapy fees back to the T ariffs C om m ittee fo r reconsideration an d clarification of certain points (a raise of 33£% has since been agreed). T he fo rm atio n o f new B ranches, such as to r instance, E ast an d W est R a n d was discussed, b u t it was pointed out th a t m ore info rm atio n an d statistics w ere required and th a t sm aller branches h ad several problem s. I t was agreed th a t th e m a tte r should be discussed at the Southern T ran sv aal B ranch A .G .M . and th a t a suggestion should come from th e B ranch an d be b ro u g h t to m e ne.u C ouncil meeting. S T A N D IN G COMMITTEES Finance Committee M rs. V ictor, T reasurer, presented th e financial report. T he F in an ce C om m ittee has m et th re e tim es since C ouncil. T h e auditors will, in future, charge for tim e spent on the books. T he financial statem ents w ere not ready fo r the m eeting but will be tab led at th e next N .E.C . m eeting. S tu d en ts’ subscriptions were clarified, nam ely all students paid R 4 c ap itatio n up to the 30th June, 1980, w hilst final year students p aid R 2 fo r the period J u ly /D e c e m b e r, 1980. N egotiations are in process w ith two firms o f insurance brokers an d a recom m en­ d atio n will be m ade to the N .E .C . after a fu rth er m eeting of th e financial com m ittee. I t is expected th a t expenses for th e IX th In tern atio n al C ongress in Sw eden will be high an d it is h oped to receive sponsorship fo r this. D onations fro m post-registration courses w ere received fro m S outhern T ransvaal an d N a ta l C oastal (two courses) B ranches. T hus fa r th ere has been a poor response to the advertisem ent fo r a p aid general secre­ tary (on a sessional basis). In discussion branches were rem inded th a t they are responsible fo r jo u rn a l subscrip­ tions fo r ho n o rary life m em bers o f the Brancn. B ranches were also requested to subm it a list of m em ­ bers w ith their categories in d uplicate so th a t one copy could go to the N .E.C . and one copy to the Journal C irculation M anager. Editorial Board M iss C h atterto n , reading th e E d ito rial B oard report, explained th a t advertising rates and non-m em ber sub­ scription rates h a d been increased in view of th e escala­ ting costs of p a p e r an d printing. A n appeal was m ade fo r a representative to m ake contact w ith potential advertisers in th e R eef area. F re e advertising on an exchange basis h ad been agreed to w ith P hysiotherapy C an ad a and Physiotherapy (C.S.P.). In discussion ttran^n Secretaries were requested to p rin t or type changes of address in d u p licate and to add postal codes. T he 103P 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. ) 104 F I S I O T E R A P I E DESEMBER 1981 O bstetric A ssociation questioned being charged R 24 for an advertisem ent and it w as explained th a t this was Jo u rn al practice where a B ra n c h /G ro u p /A sso c ia tio n charged for the course being run. Registration Committee In reporting on the R egistration C om m ittee M iss de B ruin said th at a n app lication form h ad been draw n up and sent to th e P rofessional B oard fo r com m ent; it is hoped th a t this will assist S.A .M .D .C . an d speed up the procedure of registration. L im ited reg istratio n was recom m ended fo r applications from A ustria and Belgium an d those fro m F ran ce an d In d ia w ere n o t reco m ­ m ended. C anada an d Z im babw e enquired ab o u t evalua­ tio n of credentials of “ foreign physiotherapists” an d the im portance o f in teractio n w ith overseas physiotherapists was stressed. A PPO INTM ENTS IN FOR M ATIO N SECRETARY The A ppointm ents In form ation Secretary, Miss Blake, stated th a t th ere h ad b een a n increase in enquiries. I t was agreed th a t N .E .C . request the exact requirem ents for registration w ith th e S.A .M .D .C . A pplicants should be w arned th a t lim ited registration could last fo r up to a year an d a certificate o r a certified copy o f registration should be sent to facilitate th e granting of a w ork perm it. SUBCOM M ITTEES A ctions Committee M rs. G lau b er rep o rted on the activities o f the A ctions C om m ittee w hich intends to em ploy a professional public relations firm to im prove th e im age of physiotherapy in th e eyes of the public an d the m edical an d allied p ro ­ fessions. T o defray th e cost o f this it w as suggested th a t a voluntary levy be placed on each m em ber o r th at Branches raise a set a m ju n t. Mrs. Keays will continue w ith the slide-tapes program m e and o th er channels of publicising physiotherapy, such as articles in M edical A ssociation new sletters, M icrophone In , A udio-M ix and the S tar are being investigated. In discussion the m eeting agreed in favour o f th e p ro ject b u t it was felt th a t sponsors could be fo u n d to help pay fo r this venture, t h e m echanism of B ranch paym ent was referred to N .E .C . fo r decision. Constitution Committee T h e C o n stitu tio n C om m ittee rep o rt was read by Miss Irw in-C arruthers. M rs. Levy h ad agreed to act on this com m ittee in an advisory capacity. T he m ost econom ical m ethod of printing am endm ents will b e investigated as it is not feasible to re p rin t the constitution as a w hole. A D HOC COMMITTEES M rs. B eenakker rep o rted on the C o m m ittee to investi­ gate services for the aged (taken together w ith the S.A. N atio n al C ouncil fo r th e A ged) and said th a t S.A .N .C .A . had discussed th e role it will play in organising the year of the aged. P osters an d pam phlets on various topics w ere being p repared , a co-ordinating com m ittee had been form ed and B ranch Secretaries had been asked to consider various proposals an d supply suggestions to th e com m ittee. I t was felt th a t people w ho care fo r the aged should be ed u cated on correct handling, an d th a t the role o f the p hysiotherapist in th e care o f geriatrics should b e em phasised b y th e m edia. M rs. H a c k rep o rted on the various interesting activities in which B ranches h ad p articip ated during the In te rn a tio n a l Y ear of D is­ abled Persons and m ade a linal appeal to sell car stickers. BRANCHES Branch representatives reported on various activities as a co ntribution lo the In tern atio n al Y ear of D isabled Persons, annual general meetings and B ranch lectures covering interesting subjects such as P erthes hip, training the visually disabled, .rheum atic conditions, sports injuries, diagnostic ultrasound, chronic obstruc­ tive airw ays disease and cerebral palsy, the use of electricity in the control of pain and to tre a t non-union of fractures, psychiatry, scoliosis and a d u lt hem iplegia, to nam e b u t a few. M rs. Shrock conducted ante-natal courses a t several of the B ranches. M aitlan d courses were held, as well as sym posia on a variety o f subjects. N o rth e rn T ransvaal reported th a t the congress pro­ ceedings should be in the post in the near fu tu re (these have since been sent out). S outhern O range F ree Stataj reported th a t they were busy organising the National- C ongress to be hosted by th eir B ranch in 1983. The them e will be “T h e Seven Ages of P hysiotherapy” . This will be follow ed by the council meeting. SPECIAL INTEREST G R O U PS/A SSO C IA TIO NS Mrs. B eenhakker reported th a t the L ectu rers’ G roup had elected M iss J. Blair an h o norary life m em ber and th at new registerable qualifications approved by the Senate of the U niversity of Stellenbosch and th e D ep art­ m ent o f N ational E ducation were: a one year B.Sc. (Hons) course in M obilisation and M anipulation; In te n ­ sive C are; Paeclirtric N eurology (N euro-D evelopm ental T herapy); A d u lt N eurology; O bstetric P hysiotherapy. A w orkshop on im plem entation of clinical exam inations rath er than exam inations bn m odels is being planned and qu arterly production of the new sletter is to be resum ed. M rs. E deling reported th a t the M anipulative T herapists G ro u p will be holding a shoulder course in N ovem ber, th a t a 72 h o u r course will be held in 1982 in conjunction with the U niversity of Stellenbosch, and th a t an article is being prepared fo r the S .A .M .J. Miss Ferguson rep o rted th a t the N ational H ospital G roup held discussions on all aspects of n ational ad m in istra­ tion and th a t M r. A. R othberg had been m ade an hono­ rary life m em ber. T he N atal and C ape branches wer&r well established and the new Intensive C are su b -g ro u # hoped to in itiate a country-w ide trial on an aspect o f ' intensive care. In reading the O bstetric A ssociation rep o rt M rs. P reto riu s stated th a t the library service is proving popular, and th a t an inform ation leaflet on starting an obstetric practice and a new 1982 register were being com piled. A day course by M rs. Shrock was held in Johannesburg. Inclusion of an item for obstetric physiotherapy in the m edical aid tariff fees is being investigated. A tten tio n was draw n to the interest shown by sports researchers, gym nasium ow ners and th e lay public in fitness in pregnancy and training centres, and m em bers were asked to stim ulate research in this field. M rs. E deling reported on the P rivate P ractitioners gene­ ral m eeting and the election o f M rs. Pilkington as h o n orary life m em ber, a m atter which h ad to be referred to N .E .C . N egotiations continued fo r an increased pro­ fessional liability insurance, a tten tio n was draw n to the proposed A ssociated H ealth Professions Bill (this has been w ithdraw n at present), th e availability of physio­ therapists to treat patients referred by the d istrict su r­ geons at adequate rem uneration was pointed out and m any m em bers in private practice were considering con­ tracting out of the m edical aid schem es due to escala­ tion in costs of running a private practice. 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. ) DECEMBER 1981 P H Y S I O T H E R A P Y 105 REPRESENTATIVES o n n a t i o n a l a n d IN TER NA TIO N AL O R GANISATIO NS Mrs. M athias, in reporting on the N atio n al Council for rhe C are of C ripples in South A frica, said that there had been much in teractio n betw een physiotherapists and the com m ittees o f C ripple C are, bu t there had been some discussion on the m otivation of the p atient by the physiotherapist an d it was felt th a t m ore could be done in this regard. Mrs. U term ohlen reported th a t the N ational C ouncil of W om en in South A frica had had various lecturers on th e I.Y .D .P . them es and w ere at present investigating the shortage in nursing and p a ra ­ m edical staff. Miss lrw in -C arru th ers said th a t the p re ­ sent chairm an of the South A frican N eurodevelopm ental T herapy A ssociation was M rs. R. B attison (a physio­ therapist). U pdating the existing standards for certifica­ tion of instructors and for design of courses, is being considered. T he 1982 course to be held in N atal is greatly over-subscribed and th ere is a dem and for a further course in the T ransvaal. ^ W .C .P .T . T here were no m otions from the S.A.S.P. to the general m eeting o f the W orld C onfederation for Physi­ cal T herapy. Two altern ate delegates are allowed (two votes) and these will be appointed by N .E .C . The agenda for the general m eeting will be sent o u t in Jan u ary 1982 and a special N .E .C . m eeting will be held to discuss this and b rief the delegates. M iss B ow erbank reported th a t she was investigating the possibility of cheaper accom m odation in Stockholm and interested persons should contact her. Two papers had been w ith­ draw n and m em bers were rem inded th at all papers had to be recom m ended by the Society. GEN ER A L In discussion it was agreed th a t a general practitioner may carry out ultra-sound therapy provided he does the treatm en t him self. It was felt th a t elderly patients who wished to a tten d K eep F it prophylactic classes need not be referred by a doctor, provided th at they are reason­ ably healthy. C oncern was expressed at the degree to which physiotherapy is being taken over by o th er pro­ fessions. N EX T M EETIN G T he next N .C .R . meeting will be held in Jo h an n es­ burg on 20 M arch 1982. BOOK REVIEWS Banus, B. S., Sukiennicki, D . R., Kent, C. A., Becker, M. L., Norton, Y . de S. (1979). The Developmental Therapist. Second Ed. Pp. 405. C harles B. Slack. N .J., U.S.A. * T he second edition of “T h e D evelopm ental T h erap ist” has been designed to convey theoretical concepts, p e r­ tinent research findings and children’s real behaviour. This qu o tatio n from th e Review on page 385 indicates the scope of the book w hich is divided into th ree parts. Section I review s the developm ental processes taking place during th e first nine m onths o f p ostnatal life. A large pull-out wall chart, T h e D evelopm ental G rid, tabulates all aspects of the tim e span and elaborates the process up to the age of 10 years. T his is a very valu­ able attachm ent. T hese chapters include inform ation on the neuro-physiological and neuro-behavioural con­ cepts and functions from b irth to adolescence. Several “ profiles” of children are used to su b stan tiate the m aterial of this section. Section II deals w ith child evaluation and treatm en t principles which establish a guide fo r therapists. T he text covers situations in w hich th e child m ay be en­ countered and activities and people w ith w hom he may be involved. T he skills o f interviewing, testing and counselling are exam ined, while w arning is given of some pitfalls. F u rth e r clarification is given in th e ap ­ pendices. Section I I I expands evaluation and treatm en t to in­ clude sensory integrative an d perceptual deficits, dis­ orders of m ovem ents and psychosocial dysfunction. In ­ cluded is inform ation covering a wide variety of con­ ditions and situations and offers m uch help to those who use it fo r reference. T h e book was w ritten in response to students’ re­ quests fo r a com prehensive book on children, their developm ent and disabilities. A s a resource fo r answ er­ ing fu n d am en tal questions it adm irably achieves its purpose. T h e five O ccupational T herapists w ho have con­ structed and w ritten this book are to be congratulated on th e com prehensive, clearly ordered an d w ritten text. T he tables, charts, excellent diagram s an d photographs illustrate and reinforce the m aterial being d ealt with, while a long list of reading references com plete each chapter. H . P . M aree Siev, E. and Freishtat, B. (1976). Perceptual D ys­ function in the Adult Stroke Patient. A M an u al for E valuation and T reatm ent. Pp. 8 - 104. C harles B. Slack. U.S.A. T he In tro d u ctio n to this book suggests th a t the percentage of b rain dam aged persons having percep­ 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. )