University of Virginia Library

INFANTILE PARALYSIS

In this obscure and troublesome affection scientific massage has won some of its greatest victories. With the aid of the electric current we first find out which muscles or which groups of muscles are affected. This should not be done however until one full month from the day of the first attack. It is a well acknowledged fact that the amount of damage done to the tissues will all depend upon how soon the disease is properly recognized, so as to promptly apply the counter irritation to both sides of the whole spinal column.

When we begin the massage we should give strokings only over the whole affected limb to increase nutrition and tone up the different parts, but the deep massage should at first be given only to the most affected muscles and their nerve supply, the other or stronger groups being severely let alone. In my own practice I have often taken cases of this

trouble and in a short time gotten the most marked improvement simply by adhering to the above rule, when before the ordinary "rubbing-massage'' had been tried for a year or more and failed to give any result. It seems to me that the attending physician should plainly write out his prescription or the massage to be faithfully filled by a competent operator.

We stretch the spinal column by movements or better still by suspension as the patient gains strength and I always arrange a horizontal bar with cleats in a doorway so that I have two heights, one for the child sitting and one for the standing position. When the braces are first put on I use a double bar fitting the height of the child like a crutch; there is also another cross-bar below to put the hands on; the uprights are slanting inward and only room enough is given for the child to get through. This is an excellent arrangement in the early starting of teaching coordination. My next move is generally to let the child push the rolling chair, if old enough; by this time there is more coordination, he will begin to balance at first for a minute, then more and more every day; now we may begin with crutches cut rather short so as to get a slight forward bend which helps to steady the patient in balancing; then only one crutch and a cane and finally the one cane. Of course it will be understood that in the meantime the child has medical tonic treatment also electricity and hydrotherapy in connection with the massage. The treatment must be given every day if there is to be any result expected.

A careful record should be kept and the most accurate measurements taken at fixed intervals. The salt air at the seashore for a short interval seems to have a wonderfully beneficial effect upon these cases and it is well to stop the massage occasionally for a week or so for a trip to the shore. The improvement will afterward be so much more rapid.

The movements which I use are principally for the spine as Lying raising of the body. At first it is often necessary to tie a sheet around the foot-board of the bed and have the patient try to pull himself up or it may be necessary for the operator or the mother who should be taught how to give these movements, to assist the child by placing the hand between the shoulder blades. Suspension, passive and active we have already discussed. Now in regard to the movements for the extremities used in connection with our massage we will take a fairly typical leg for demonstration: the foot is constantly extended, hence we flex the foot (much easier done if the leg is flexed at the same time) to overcome the contraction of the extensors. The foot is not only extended but also everted; consequently we invert it with our flexion. The same child can draw her leg up but can not possibly push it down or in any way extend it, hence we practice extension of the leg; the right leg she can bring in to the median line hence her adductors of the right side are saved, but she lacks power of rotation outward so we give that movement to act upon the biceps femoris

and the gluteus maximus. The operator must of necessity study out each individual case to obtain good result, as there are never two cases of polio-myelitis exactly alike.

On account of the excellent results that the author has had in treating this affection, it has frequently been suggested that he had some new, secret methods of treatment, but such is not the case and any intelligent and qualified operator will by following the above instructions have the same good results. It should also be mentioned that I frequently make use of exercises similar to those described by Fraenkel to help along coordination. On a board I draw two large, round points connected with a line and make the child learn to follow this; afterwards I make a triangle in the same way and later a semi-circle or an ellipse. I have found these simple exercises of great practical value.