THE
HANDICAPPED
CHILD
A
Symposium
M. A. PERLSTEIN, M.D., CHAIRMAN
CLINICAL CORRELATION BETWEEN ETIOLOGY AND
SYMPTOMATOLOGY IN CEREBRAL PALSY
M. A. PERLSTEIN, M.D.
Northzvestern Uniz’ersity Medical School, Chicago
DEVELOPMENTAL DIAGNOSIS IN CEREBRAL PALSY
ARNOLD GESELL, M.D.
Yale University, New Haven, Conn.
4.
PREVENTION OF DEFORMITIES IN NEUROMUSCULAR HANDICAPS
(Abstract not available)
JOHN POHL, M.D.
Minneapolis
REVASCULARIZATION OF THE BRAIN
(Abstract
not
available)
CHARLES
F.
MCKHANN, M.D.Western Reserve University School of Medicine, Cleveland
4.
FACILITIES AND PROGRAMS FOR AID TO THE HANDICAPPED
Miss JANE SHOVER
National Society for Crippled Children and Adults, Inc., Chicago
140 SYMPOSIUM: THE HANDICAPPED CHILD
CLINICAL CORRELATION BETWEEN ETIOLOGY AND SYMPTOMATOLOGY
IN CEREBRAL PALSY
M. A. PERLSTEIN, M.D.
There is a great deal of correlation between the various types of clinical pictures seen in cerebral palsy and the etiologic factors. Thus there are certain noxae which have a predilection for certain portions of the brain. Anoxia tends to attack the extrapyramidal tract system, whereas hemorrhages tend to attack primarily the pyramidal tract.
Thus, one can often prognosticate on the basis of history the clinical pictures which are found.
A classification of the various types of cerebral palsy can thus be based either upon an etiologic
basis or upon a clinical basis.
Some Clinical Common Correlates in Cerebral Palsy Where history is: Common neurologic sequela is:
1. Prematurity Spastic paraplegia
2. Breech delivery Athetoid or spastic paraplegia 3. Toxemia of pregnancy Spastic hemiplegia
4. Birth trauma Spastic quadriplegia
5. Anoxia Athetoid
6. Rh factor Athetoid with deafness and paralysis of supraversion
7. Maternal rubella Spastic with deafness or auditory aphasia, cataract, congenital heart 8. Precipitate or cesarian Spastic quadriplegia or rigidity
DEVELOPMENTAL DIAGNOSIS IN CEREBRAL PALSY
ARNOLD GESELL, M.D.
The concept of development has far reaching implications in the diagnosis and the care of the handicapped child. Every infant, whether normal or handicapped, is confronted with the task of achieving his allotted measure of maturity. We cannot understand him unless we know something of his growth potentials.
For this reason, a considered developmental approach is desirable in our clinical procedures and treatment policies. Such an approach needs to be implemented, if it is to go beyond a mere philosophic
attitude.
It should be pointed out that a developmental examination of an infant’s behavior is not a psycho-metric I.Q. test. It is a more comprehensive observation of the total maturity status of the child, as
manifested by diverse types of behavior patterns-motor, language, adaptive and personal-social.
To the infant the various test objects are so many toys which he exploits by eyes, hands and mouth. To the examiner the behavior tests are devices by which he elicits for careful inspection the
maturity and the organization of the child’s action system. In cases of cerebral palsy each behavior
test becomes a diagnostic tool for detecting and defining neurologic deviations. A developmental type of behavior examination is especially effective for detecting, in infancy, slight but unusual deviations
in eye-hand coordination and atypical exploitation patterns, which indicate a minimal type of cerebral
injury.
In clinically experienced hands, a developmental behavior examination conducted formally, with precision of purpose, serves 5 functions as follows: 1. It ascertains stages of maturity and rates of development in infant and child, both normal and handicapped, 2. It yields an analytic diagnosis
ACADEMY PROCEEDINGS AND REPORTS 141
FACILITIES AND PROGRAMS FOR AID TO THE HANDICAPPED
JAYNE SHOVER
Reaching our common goal of medical and allied care for the estimated 750,000 to 1,000,000
orthopedically handicapped requires teamwork of the highest quality among agencies and individuals
concerned. Services to meet a part of this need have been set up by the Crippled Children’s Services in the United States Children’s Bureau, the United States Office of Education, the Office of Vocational Rehabilitation and the Veterans’ Administration. These services come down to the local level through state departments of health, education and welfare; state schools, hospitals and institutions for the
handicapped; state employment offices; and public schools and county and city health departments.
Voluntary agencies make an additional important contribution. Flexible and adaptable to varying community needs, they bring the problem to public attention ,and promote the research and experi. mentation essential to forward-looking programs. Among the national private, nonprofit agencies concerned with the physically handicapped are: the National Society for Crippled Children, National Foundation for Infantile Paralysis, American Heart Association, American Cancer Society, American Hearing Society, National Epilepsy League, and the National Tuberculosis Association. Those with particular concern for the orthopedically handicapped are:
1. The National Foundation for Infantile Paralysis, which provides emergency epidemic aid in
poliomyelitis, medical and surgical care, hospitalization, nursing, physical therapy, orthopedic
appli-ances, transportation of patients to clinics, supply of equipment to hospitals, and funds for personnel
training and research.
2. The National Society for Crippled Children and Adults, the Easter Seal Agency, is a nationwide
federation of more than 2,000 state and local member societies. Included in its program are special diagnostic clinics; medical and convalescent care ; physical, occupational and speech therapy; cerebral palsy services; special teaching in crippled children’s classes, and in homes, hospitals and convalescent care institutions; recreation; curative and sheltered workshops; employment placement; social service; and provision of prostheses, appliances and equipment.
Highlights of the Cerebral Palsy Program of the National Society in 1950 indicate that (1) largely as a result of this program, the number of cerebral palsy centers in the United States has grown from 16 to over 200 in 4 years, (2) the Easter Seal agencies have spent approximately $8,000,000 on cerebral palsy since 1946, including one third of a million dollars in scholarships for personnel
train-ing; and (3) the number of physicians with special training and experience in cerebral palsy has
increased from 10 to 150 in 4 years.
The Cerebral Palsy Division provides consultation by specialists in organizing facilities for the care, education and rehabilitation of the cerebral palsied. Constant guidance is secured from liaison
officers from the American Medical Association, the American Academy for Cerebral Palsy, the Amer. ican Academy of Pediatrics and other medical and specialty groups. The Society also works in
co-operation with physicians and other public and private agencies in program development.
Volunteer efforts are basic to the effective operation of the cerebral palsy program of the National Society. Many organizations, clubs, fraternal and civic groups have sponsored or cooperated in special projects on national, state and local levels through the National Society, in addition to the generous expenditure of time and effort by individuals.
It is the earnest desire of the National Society for Crippled Children and Adults to be of every possible assistance to pediatricians. Its comprehensive library of books, pamphlets and reprints, as well as its library of film slides and photographs, are available for lectures and exhibits. The bimonthly Crippled Child magazine publishes articles contributed by medical specialists and authorities in many fields serving the crippled.
Professional consultants on the staff of the National Society can be helpful in planning new
services or extension of existing facilities. An extensive list of resources for the handicapped is
