In Our Care: "Cerebral Palsy"
Ray Stewart of WOI-TV Ames, Iowa along with Iowa State University, produced "In Our Care," a 13 week series of documentaries filmed inside Iowa's state institutions. The series won the 1952 National Sylvania Television Award for Production Excellence.
(Voiceover) Cerebral palsy, palsy, palsy...
Ray Stewart: I have something over here I'd like to show you. A tricycle for a little boy that has a framework on it to keep him from falling off, to strap him in, to strap his feet to the pedals so they won't come off. A regular tricycle with modifications. Want to go skiing? These are children skis but not for snow. We strap them in here as you do with some skis, but these are for walking in various corrective actions.
Ray Stewart: You're familiar with canes. Two canes are necessary for some children to walk. They're easy to control and under certain circumstances can get along quite well.
Ray Stewart: Knee braces for the legs. Stiff, but it allows the children to walk sometimes.
Ray Stewart: When necessary a cane, a crutch.
Ray Stewart: Another type of ski for corrective purposes prevents and corrects certain types of walks.
Ray Stewart: Little children wearing corrective braces to prevent certain types of malformation and so forth. If you are normal, can you imagine what it would be like to be inside of a body over which you no control? I have something else I want to show you.
Ray Stewart: Now you probably think of a child with cerebral palsy as a spastic. You may describe a spastic as a drooling, grimacing, particularly uncoordinated individual. And in some instances, you would be right.
Ray Stewart: If you entered a nursery school and saw this cute little boy, chances are you would call him spastic because of his lack of muscular control.
Ray Stewart: Dave here has trouble holding his head in place.
Ray Stewart: And Lonnie can't control his spoon when he tries to eat.
Ray Stewart: You can see how difficult it is. An all-inclusive term, spastic is incorrect. Spastic is but one of five types of cerebral palsy.
Ray Stewart: Look at these children. Could you say as readily that they are palsied? They have cerebral palsy just as surely as the first children did. But they have different types and some are less severely involved. And of course the fact that most of them are sitting down hides some of their handicap.
Ray Stewart: Cerebral palsy is not a disease. It is a condition in which some brain centers are destroyed, centers which control muscular action and coordination. Most cases can be traced to damage before or during birth. Such being the case, cerebral palsy is no respecter of class or station in life. It can happen in any family.
Ray Stewart: Now take for example, the James L. Jensen family of Ames, Iowa. Mr. Jensen works for the city, has a nice home over on South Riverside. Their daughter Princetta is 5 years old. Princetta has cerebral palsy. I visited the Jensens the other night, and I asked Mrs. Jensen when she first suspected that Princetta had cerebral palsy.
Mrs. Jensen: We never really suspected Princey as having cerebral palsy because we'd never heard of cerebral palsy at that time. When she was a baby, cerebral palsy hadn't really been publicized very much. But, upon taking her to the doctor for her yearly medical examination, he diagnosed her as being a spastic, which we later found was one type of cerebral palsy.
Ray Stewart: Now that you look back, Mr. Jensen, is there anything that you would recognize as being spastic now?
Mr. Jensen: As I think back, I can, yes. At that time, because she as a premature child, I didn't think too much about it.
Ray Stewart: I see. The doctor then found this. What have you been able to do for her in the five years?
Mrs. Jensen: Well, we've taken her as an outpatient at the Cerebral Palsy Clinic in Des Moines and last summer she spent seven weeks at the hospital school in Iowa City. And she has had physiotherapy and occupational therapy.
Ray Stewart: Can she stand?
Mrs. Jensen: Not by herself.
Ray Stewart: Well, what do you…? How do you treat her? Do you keep her at home all the time.
Mrs. Jensen: No, she attends public school. She goes to kindergarten this year.
Ray Stewart: Oh, I see. She started this last year. Well, how did she get along there?
Mr. Jensen: She gets along fine. She has a lot of friends. She loves school. She goes every morning.
Ray Stewart: Well, if she can't walk or stand, what do you, what does the teacher do with her at school?
Mrs. Jensen: Well, she ah…. I take her to and from school in the wheelchair and then we got another little chair from school with wheels on it and we tie her in that chair and the teacher can wheel her around then in school.
Ray Stewart: Now, she has brothers and sisters at home, doesn't she, Mr. Jensen?
Mr. Jensen: Yes, she has two sisters and a brother, all younger.
Ray Stewart: All younger. So you had no specific information, I mean by comparison, about this development. If you had a little more information, maybe you would have known sooner that she was spastic.
Mr. Jensen: I think we would have, yes.
Ray Stewart: Of course, if there would have been other children in the family, you might have noticed.
Mr. Jensen: We would have known earlier yes.
Ray Stewart: I imagine it is somewhat difficult in a first child.
Mrs. Jensen: Particularly since she was premature, that was what we blamed most of her slowness on.
Ray Stewart: What advice would you offer now to parents who might have cerebral palsied children, as far as early findings are concerned?
Mrs. Jensen: The earlier the finding and the earlier the treatment, the better chance the child will have of getting turned around sooner and I think the treatment is a little easier when the child is younger.
Ray Stewart: Now tell me about Princetta's future. What do you think is in store for her? How will she get along?
Mrs. Jensen: We have every hope that eventually she will be walking. She has means and determination to get around. Of course, it won't be a matter of just a few days, weeks, or months, but it seems to be over a period of years. And it's up to us to keep the will and determination so that she continues to have this determination.
Ray Stewart: To be able to achieve some degree of independence is the greatest need of the cerebral palsied. But independence must be developed and practiced.
Ray Stewart: Ronnie here cannot walk alone but he has learned to move with his handicap by using his chair for support. He can get on his tricycle. Ronnie is athetoid. Athetoids and spastics make up 85% of all cerebral palsy cases. Ronnie needs help to get on his tricycle. His feet must be strapped on the pedals, and once he is securely in place, he can ride alone. Palsied or not, Ronnie is learning to be independent. Palsied children more than any other children, must learn to play and develop their social skills.
Ray Stewart: Actually, the disabilities of a palsied child are magnified by the attitudes of his parents and those around him. In skillfully supervised cerebral palsy centers, such as the one on Des Moines, Iowa, they roll balls to each other or go out for healthy play on the lawn, as any other child would do. They're not quite as nimble but they're every bit as gay.
Ray Stewart: Also, like other children, palsied children grow up. Today, thousands of men and women are confined in homes or institutions for the feeble minded who need not have been if cerebral palsy had been as well understood when they were children as it is today. Only recently have we realized that the majority of our cerebral palsy cases are not feeble minded.
Ray Stewart: Integration and independence where possible do not just happen. They require hours of training and intensive practice under the guidance of expert therapists. The aim of cerebral palsy treatment is to integrate as many of these children as possible into society to help them live within their limitations. Jeannie has just learned to stand alone. Her full braces make it possible for her to stand alone for a full minute. These children want to wear braces because they realize that braces help them do things that they couldn't have otherwise do. Things like standing alone, playing in the sandbox. Every day things to most children, but they are great accomplishments to the palsied child. It is important that these children feel loved and wanted. Proper attitudes of parents must be encouraged. Proper attention and loving patience must be felt by the child and they must be helped in finding their place in the world. Ann here has to be strapped to the sandbox to be prevented from falling, but she is learning to stand and to play with other children.
Ray Stewart: Just how far their training can progress is limited only by the child's ability to adjust and to train. Now to train substitute nerves and muscles to restrain those unwanted spasmodic movements, the palsied child needs enormous determination, patience, and gadgets. And much of the training for cerebral palsied children comes through physical therapists like Mrs. Jane Sullivan, a physical therapist from Des Moines, who is here with me now. Mrs. Sullivan, tell me what is physical therapy.
Mrs. Sullivan: Well, physical therapy covers a lot of territory. Do you mean physical therapy just as it involves cerebral palsy children?
Ray Stewart: Yes, I imagine there's a considerable difference.
Mrs. Sullivan: Yes, there is. With cerebral palsy children, we usually begin with simple things like basic motion training.
Ray Stewart: But, what… what do you mean?
Mrs. Sullivan: Well, when a child ordinarily starts to kick, he kicks one foot and then the other. Cerebral palsied children don't always do that. They kick two at a time and first they must learn to kick one leg and then the other. Then we go on and follow the normal development as closely as possible that the average child would go through in growing up.
Ray Stewart: More like coordination.
Mrs. Sullivan: Yes, coordination. Actually, we get them so young that you can't start coordination a great deal. We use nursery rhymes to condition them for coordination. And then we go through rolling over and getting up on their hands and knees, crawling, and in the direct sequence that a child follows in learning to sit and stand.
Ray Stewart: How young can you start physical therapy on a palsied child?
Mrs. Sullivan: We have started as young as 9 or 10 months and, at that, age we would start with rolling over and starting to get up on their hands and holding up their head. Head control you can start at that age. What we really like to do with a child as young is to instruct the parents in what to watch for, and we follow their age as closely as possible.
Ray Stewart: Now tell me, when they get up to the walking age, that's where this coordination and the alternate movement of legs is concerned. How do you accomplish that after they can stand and you've done a lot of other things?
Mrs. Sullivan: Well, among other things, we use skis.
Ray Stewart: Skis. I should add here. I made some motion pictures of this because I thought it was sort of interesting that this was Stevie on the skis. What are you able to do for him?
Mrs. Sullivan: Well we use the skis with Stevie because he has a lot of uncontrolled motion and he tends to stiffen or to cross his feet when he walks. The skis are built up on the inside, which prevents the skis coming together. You'll notice, they're quite high and they can be weighted down to hold the uncontrolled motion. His feet can't possibly cross with those box type skis. Now it's necessary…
Ray Stewart: I notice he is having trouble with his hands there.
Mrs. Sullivan: That's right. He has to learn to grasp and to hold on and then to release when it's time.
Ray Stewart: What are these? I had one of those a moment ago.
Mrs. Sullivan: Well, those are used mostly for balance. That little girl can walk but needs training to correct her walking and improve it. And she needs to learn to balance on one foot and then the other, rather than to favor one…
Ray Stewart: Is that what she's doing there, where she rolls back and forth?
Mrs. Sullivan: That's right. She's being taught to balance on one foot and then the other in order to get the proper training to walk.
Ray Stewart: I notice as she gets out across, as she finally stops that. But she seems to be doing pretty well.
Mrs. Sullivan: That's right.
Ray Stewart: And what are these - parallel bars?
Mrs. Sullivan: Those are parallel bars. Blaine is learning again to correct his walking. He can put one foot ahead of the other, but he must learn to stand more erect and to gain a little more balance before he'll walk alone.
Ray Stewart: Well, thank you very much, Mrs. Sullivan. I appreciate the fact that there's much more here than we have been able to say. These words and demonstrations become more meaningful when you can actually see results. Now, this little boy that we're going to show you is Jerry Horpestad. This film was made in 1951, almost two years after he first attended the cerebral palsy clinic. He couldn't walk or stand alone, although he wore short, corrective braces. Jerry had to be helped to the table where he could sit alone and play. That's Mrs. Sullivan with him. This is Jerry today. He is 6 years old. He is all the way up those practice steps and down again without any help. Now, he wears full leg braces. And he has learned to balance himself and to walk alone. He is walking now, but he would be a hapless invalid if he hadn't received proper treatment and habilitation. Jerry had to learn from the beginning the things which come as routine to most children. He's gay enough.
Ray Stewart: Palsied children, depending on their degree of involvement, need to learn control of practically every movement they make. Your child would reach for a cookie and hold his own glass. But little Ronnie here, who is not yet 4, has to learn to reach and to connect and to direct his hand to his mouth. Left alone and without guidance, he has great difficulty feeding himself. Now, the occupational therapist knows that if she secures his legs in place so they won't move spasmodically, Ronnie will be better able to control other muscles necessary for feeding himself. When many muscles need attention for control, it becomes difficult to centralize attention on one particular effort, such as eating. And to give him more help, a suction cup is used to hold his bowl and a special handled spoon is provided so that he can hold on to it better. The suction cup holder is not special equipment for handicapped children. It is often used in training babies to feed themselves. That spill-proof cup is available in many places and mothers of small children everywhere find them useful. These things which are conveniences for parents of normal children become virtual necessities in the proper training of palsied children.
Ray Stewart: The occupational therapist helps Ronnie get the feel of proper movement by guiding his hand with her own. He is learning to feed himself and like any other child, he needs training, only he has to work harder and longer than other children, and he may never be able to control his muscles completely. Only reeducation of the brain by special training routine is effective in improving these children.
Ray Stewart: All cerebral palsied children can be helped in some worthwhile way. Many can go a long way even where least expected. Now occupational therapy is a development of skills used in everyday living. Five-year-old Stevie here is learning to lace shoes. He has trouble coordinating eye and hand movements and so this educational toy is used for the training he needs in learning to gain independence in dressing himself. Difficulties in eye-hand coordination are common among palsied children. Proper training can happen in varying degrees. Children often learn to dress a doll as a first step in learning to dress themselves. Notice Stevie's intense concentration necessary to getting the task done. The cerebral palsied child often has a short attention span and is easily distracted.
Ray Stewart: And because so many muscles are involved, over 70% of all cerebral palsy cases have speech difficulties. Since speech is important in developing social skills and desired independence where possible, speech therapy is an important part in habilitating the palsied child.
Ray Stewart: Hand puppets, like this funny witch, put an element of fun into speech training. Proper tongue movement requires guidance and practice and encouragement, as does shaping of mouth for 'ooh' and 'eeh.' Controlled breathing is difficult to acquire. The child must want to talk and must want to do the things that will improve his speaking. That's why toys and suckers and elements of games and fun are employed in the therapy. A sucker is used as bait to train difficult tongue movements. Blaine licks the sucker and then tries to move his tongue around for another taste. If better tongue movements in the palsied child can be developed, it offers encouragement for further speech improvement. Learning to blow out candles helps develop breath control too. And Stevie is going to be ready for his next birthday.
Ray Stewart: It is entirely possible that, during this program, another palsied child was born somewhere in these United States, for it is estimated that 47 children are born each day with cerebral palsy. One child in each 200 births is palsied to some degree. Cerebral palsy is more widespread than the crippling effects of polio. Once the tendency was to hide these children, to give them up as hopeless invalids or feeble-minded. But attitudes and knowledge are changing that, and we're becoming more sensible about this thing. And sitting here with me tonight is Dr. Walter Abbott, a neurosurgeon from Des Moines. Tell me Dr. Abbott, what is the medical attention given to aid cerebral palsy?
Dr. Abbott: Well, Ray, I think the first thing is the early recognition of this less fortunate child. Mrs. Jensen mentioned earlier in the program that this was their first baby, Princetta, and they had noticed that she didn't develop quite as well as some of the neighbors' children. Had they had an older child, maybe this would have become more apparent to them at the time. We feel that, as you have outlined in the number of children that are born, as you said, one during the course of this broadcast, that early recognition perhaps a premature birth, perhaps a nursing problem, a feeding problem, perhaps convulsions, that may occur immediately after birth. A blue baby, breath holding, and then feeling the little soft spot or, as we call it, the fontanelle, on top of the skull. If that is tight, sometimes the early recognition of a collection of blood, that may lead to surgical removal and cure of the child. If this is not apparent, if the child does not develop well, family doctor, pediatrician is aware of that. Then the conditioning of the parent, I think, is most important, that they must adjust to the fact that their child is less fortunate than some of the others.
Ray Stewart: Now if they suspect that there is anything wrong with their child, should they go immediately to their family doctor?
Dr. Abbott: I would suggest they consult their family doctor immediately or their pediatrician. And in due course of time, he will recommend a consultation with the appropriate specialist.
Ray Stewart: Now, as a neurosurgeon, I am going to ask you a question that I think you possibly have been asked before. Is there any operation possible to correct cerebral palsy?
Dr. Abbott: Only shortly after birth where a localized blood clot may be removed. However, if the child is a cerebral palsy victim, then cutting nerves, cutting muscles, transplanting muscle, that is not successful. Sometimes, as Mr. Jensen mentioned, joint surgery at a later date after muscle rehabilitation and muscle education that Mrs. Sullivan brought out, may be of value in an adjunct to the whole program of rehabilitation. But I thing I would like to emphasize more than anything else is the early recognition by the parents, their recognition of the fact that they have a happy but a less fortunate child, and proper corrective methods.
Ray Stewart: Well… Let's go over that again for a moment. You say that… I'm picking up some of these things as I learn them, many of them more important than the other. For instance, this soft spot not soft.
Dr. Abbott: Well, I think that is the only indication where perhaps early surgery may be of value. Otherwise, it is brought out that the recognition and acceptance of the challenge to help this child because two-thirds of the children born with cerebral palsy can be rehabilitated to varying degrees.
Ray Stewart: Well now, I'm wondering if there is anything that can be done to prevent this or do you think there is any reason for guilt that some parents might have? Is this something that they could have prevented?
Dr. Abbott: None whatever. I think that it is just good fortune that most people are born as well as they are.
Ray Stewart: And so actually, only a minority of cases are born this way. You feel in an overall picture, we really are fortunate.
Dr. Abbott: And speaking of born that way, and you would think that we had rehearsed this, there is an autobiography by Dr. Carlson, who himself is a spastic, that I have recommended to many of my patients born that way, which if they read they will accept the problem.
Ray Stewart: Now that's very interesting, Dr. Abbott. Thank you very much. In a short program like this, we can only skim lightly over a subject such as we have tonight. The proper understanding of cerebral palsy is important, and I'm anxious that you know more about cerebral palsy, even though you do not expect to have close contact with it. One of the best sources for general information on the subject is this Public Affairs pamphlet titled "Help at Last for Cerebral Palsy." Because we want you to have this information, we have enough copies here at the station to send a free copy of this booklet to each person in our TV audience who writes in. If you would like to have a free copy of this booklet "Help at Last for Cerebral Palsy," just drop a letter or a postcard to me, Ray Stewart, here at WOI TV in Ames. Even if you do not expect to have contact with cerebral palsy, I believe you will profit by reading this pamphlet. Cerebral palsy begins at birth. Once it has been discovered, the future of the child depends upon a helping hand from others. A palsied child's future is the responsibility of every person he contacts. So much depends upon acceptance by the community and upon understanding of the emotional as well as a physical handicaps of the cerebral palsied, that the brightness of their future depends upon a spiritual as well as practical helping hand from us all.
(Voiceover) The worst sin towards our fellow creatures is not to hate them but to be indifferent to them. That is the essence of inhumanity.
(Voiceover) In Our Care is a public service presentation of WOI TV Iowa State College, Ames, Iowa and was produced by Ray Stewart, assisted by Marguerite Theobald. The Director was Jake Dunlop. Cinematography by John Raddatz. Technical Director, Chuck Hawley. If you would like a free copy of the booklet "Help at Last for Cerebral Palsy," send a postcard or letter with your name and address to Ray Stewart WOI TV Ames, Iowa.