SEPTEMBER 1981 P H Y S I O T H E R A P Y 79 CORRESPONDENCE D e a r M a d a m , A t a re c e n t N .D .T . W o rk s h o p h e ld b e fo re th e 14th N a tio n a l C o u n c il M e e tin g o f th e S o u th A f r ic a n S o c iety of P h y s io th e ra p y , w e fe lt d istre s se d a n d c o n c e rn e d a t c e rta in a ttitu d e s w h ic h se e m e d p re v a le n t a m o n g th e th e ra p is ts p re se n t. A seven y e a r o ld S p a stic D ip le g ia w as p re s e n te d by a p h y sio th e ra p ist w h o m w e o n ly la te r l e a rn e d w as th e c h ild ’s m o th e r. T h e c h ild b e g a n w a lk in g re la tiv e ly re ce n tly fo llo w in g lo w e r lim b su rg e ry a n d p re s e n te d with n u m e ro u s p h y sic al p ro b le m s a n d p o o r g a it. i n th e discussion th a t fo llo w e d , it w as su g g e ste d th a t : • M a y b e sh e w o u ld d o b e tte r in a w h e e lc h a ir to p re serv e h a n d fu n c tio n . • She w o u ld la n d u p in a w h e e lc h a ir a n y w ay . T h e la tte r lo n g te r m p re d ic tio n w as, w e fe lt, im p o s ­ sible to m a k e a t th is sta g e. W e a lso th o u g h t th a t a decision o f su c h m a jo r im p o r ta n c e as t h a t o f d e cid in g p u t a ch ild in to a w h e e lc h a ir fo r th e re s t o f h i s / h e r fife sh o u ld o n ly b e m a d e a f te r v ery c a re fu l c o n s id e ra ­ tion a n d d isc u ssio n w ith a ll m e m b e rs o f th e te a m , in p a rtic u la r th e p sy c h o lo g is t a n d so c ial w o rk e r. As p h y s io th e ra p is ts w e s h o u ld be a w a re o f th e g re a t im p o rta n c e o f w a lk in g , n o t o n ly in r e la tio n to le a rn in g b ut also in re la tio n to s o c ia l-e m o tio n a l d e v e lo p m e n t (B obath, 1971; J a c o b s o n & S tra k e r, 1979; E rik s o n , 1977). T h e sig n ific a n ce o f w a lk in g f o r th e p sy c h o lo g ic a l w elfare o f b o th c h ild a n d fa m ily c a n n o t b e u n d e rs ta te d . Kogan e t al. (1974) in th e i r a c c o u n t o f th e p ro c ess of in te rp erso n al a d a p ta tio n b e tw e e n m o th e rs a n d th e ir c erebral p alsied c h ild re n , fo u n d t h a t m o th e rs e x h ib ite d som e loss o f a ffe c tio n f o r th e ir c h ild , p a rtic u la rly w hen th ev w ere n o t yet w a lk in g by th e e n d o f th e stu d y . Such a ttitu d e s as th o se m e n tio n e d c a n o n ly h a v e a d e trim e n ta l effect o n th e c h ild ’s p ro g re ss. S u re ly o n e of o u r g o als as p h y s io th e ra p is ts is, w h e re v e r p o ssib le , to get the c h ild o n h i s / h e r fe e t, e v en if a m b u la tio n is n o t alw ays a tta in e d . W h e th e r th e c h ild is i n d e p e n d e n t o r needs to be c a re d fo r, d o e s n o t th is goal re m a in th e sam e? T h e a b ility to sta n d , to tr a n s f e r o r to ta k e a few steps w ith a ssista n c e c a n g re a tly fa c ilita te th e m a n a g e ­ m ent of th e m o re se v e re ly h a n d ic a p p e d . F o r a fu n c tio n a l w a lk e r to d e te rio ra te to su c h an ex te n t as to re q u ire a w h e e lc h a ir m u st b e re la tiv e ly r a re a n d th e e x c e p tio n r a th e r t h a n th e ru le . W e w o u ld be in te re s te d to k now w h e th e r th e r e a re fig u re s to r e fu te this. H o w m u c h d o we k n o w a b o u t fa c to rs le a d in g to th e d e te rio r a tio n o f h a n d fu n c tio n in re la tio n to w a lk in g ? S p in a b ifid a c h ild re n u sin g th e ir h a n d s f o r w a lk in g a id s o r m a n o e u v rin g w h e e lc h a irs, w e re fo u n d to h a v e th e ir d e g re e o f m a n ip u la tiv e skill d e p re ss e d (R o se n b lo o m , 1971). T h is w as th o u g h t to b e d u e to th e d e c re a s e th e y su ffe red in m a n ip u la tiv e le a rn in g o p p o rtu n itie s . W e w o u ld b e g la d to k n o w if th e re a r e o th e r re le v a n t s tu d ie s in r e la tio n to d e te rio r a tio n o f h a n d fu n c tio n ? F ro m th e stu d y m e n tio n e d , it fo llo w s t h a t p u ttin g a c h ild in a w h e e lc h a ir w o u ld h a v e th e s a m e re su lt as th e u se o f w a lk in g a id s, a n d try a n d s to p a ch ild p ro p e llin g th e ir ow n w h e e lc h a ir. T h e c h ild p re s e n te d a t th e w o rk s h o p h a p p e n e d to be a fre e w a lk er. It w o u ld b e in te re s tin g to k n o w w h e th e r a n y th in g h a s b e e n d o c u m e n te d o n d e te r io r a tio n o f h a n d fu n c tio n in fre e w alkers. T h e f u tu r e o f th e h a n d ic a p p e d ch ild lie s very m u c h in th e h a n d s o f th o se w h o tr e a t th e m . L e t us, as t h e r a ­ pists, th e r e f o r e be in fo rm e d a b o u t th e im p lic a tio n s o f th e d e c isio n s w e m a k e , as well as giving th e m o u r m o st c a re fu l c o n s id e ra tio n so th a t th e f a te o f th e c h ild re n in o u r c a re is d ire c te d in th e ir b e st in te re s ts. Y o u rs sin c e re ly , M . G o o d m a n (M rs) P. B la k e (M iss) R e fe re n c e s B o b a th , B. (1971). M o to r d e v e lo p m e n t, its e ffect o n th e g e n e ra l d e v e lo p m e n t a n d a p p lic a tio n to th e tre a tm e n t o f c e re b ra l palsy. P h y s io th e r. 57, 526 - 532. E rik s o n , E . H . (1977). C h ild h o o d a n d so c ie ty . T r i a d / P a la d in . L o n d o n . J a c o b s o n , R . S. S tra k e r, G . (1979). H a n d ic a p p e d c h ild ­ r e n : e m o tio n a l d e v e lo p m e n t a n d ro le o f th e ra p is t. S .A . J. P h y s io th e r ., 35, 91 - 9 3 . K o g a n , K., e t at. (1974). T h e p ro c e ss o f in te rp e rs o n a l a d a p ta t io n b e tw e e n m o th e rs a n d th e ir c e re b ra l p a ls ie d c h ild re n . D e v . M e d . C h ild N e u r ., 16, 518 - 527. R o s e n b lo o m , L. (1971). T h e c o n tr ib u tio n o f m o to r b e h a ­ v io u r to c h ild d e v e lo p m e n t. P h y s io th e r ., 57, 159 - 162. CLASSIFIED P H Y S I O T H E R A P I S T R E Q U I R E D P h y sio th e ra p ist re q u ire d f o r p riv a te p ra c tic e in P ie te r ­ m aritzb u rg from 2 N o v e m b e r 1981 fo r 8 - 1 2 m o n th s . Phone: (0331) 6-1018. L O C U M R E Q U I R E D Locum re q u ire d fo r P riv a te P ra c tic e in V e ree n ig in g . hone: (016) 2 2 -3 2 7 7 office h o u rs o r w rite to: 2 4a sm u ts A venue, V e re e n ig in g , 1930. P H Y S I O T H E R A P I S T R E Q U I R E D tr r h 11̂ "t ‘m e P h y s io th e ra p is t, c o n v e rs a n t w ith M a itla n d tiii-,iniC,n f s ’ re