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Prognosis in Cerebral Palsy a Review of 101 Consecutne Children Who Left the Forest to School for Cerebral Palsied Children During the Years 1956 - 1961 W

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Prognosis in Cerebral Palsy a Review of 101 Consecutne Children Who Left the Forest to School for Cerebral Palsied Children During the Years 1956 - 1961 W 12 Januarie 1963 S.A. TYDSKRIF VIR GENEESKUNDE 23 PROGNOSIS IN CEREBRAL PALSY A REVIEW OF 101 CONSECUTNE CHILDREN WHO LEFT THE FOREST TO SCHOOL FOR CEREBRAL PALSIED CHILDREN DURING THE YEARS 1956 - 1961 W. L. F. HATCHUEL, M.B., B.CH. (RAND), M.R.C.P. (EDIN.), D.C.H. (R.C.P. & S., E 'G.) General Practitioner to the Forest Town School for Cerebral Palsied Children, Johannesburg* The past 15 years have witnessed a world-wide growth in intelligence. The earlier idea that treatment of the spastic the facilities offered to children suffering from cerebral limbs would enable a child to take his place in society palsy. For many years parents seeking advice in the has now been modified. Workers in the field have be­ management and care of their cerebral palsied child come aware of the fact that an estimate of the u1timate were told that nothing could be done. During the late '4Os prognosis for any individual will depend not only on the and early '50s, a wave of enthusiasm, engendered mainly degree of the motor disability, but also on the basic by parents, swept the world. The growth of the United intelligence of the child. Cerebral Palsy Association in America, the National Spas­ The Forest Town School for Cerebral Palsied Children tic Society in England, the Transvaal Association for the. has now been in existence for 13 years. It is thought that Care of Cerebral Palsy in Johannesburg, and other similar it would be of interest to report what has happened to bodies all over the world, offered new hope to those the children who have passed through this school to other afflicted. places. It is hoped that this investigation may be of some It was the popu1ar belief 10 or 15 years ago that the use in trying to assess the future needs of cerebral palsied cerebral palsied child housed a normal brain within a children and also the future responsibilities of those who deformed body. This idea, however, wou1d appear to have have to deal with the cerebral palsied among our been over-optimistic. We now know that, in addition to popu1ation. the motor disabilities occurring in cerebral palsied children, there are always other defects such as percep­ During the period 1956 - 1961, 101 children left the tual and sensory losses and, in most cases, impairment of school after having spent a shorter or longer time there (Table D. Among these 101 children 6 were transferred TABLE t. DESTINATION OF 101 CONSECUTIVE CHILDREN to the Pretoria Cerebral Palsy School for geographical WHO LEFT FOREST TOWN SCHOOL FOR CEREBRAL PALSIED reasons (Table m. Seven were transferred elsewhere, but CHILDREN DURING THE PERIOD 1956-1961 Cerebral palsied children transferred for geographical reasons 6 TABLE n. TRANSFERRED TO PRETORIA SCHOOL FOR Cerebral palsied children discharged and later readmitted . 7 GEOGRAPffiCAL REASONS Age Total 13 File No. (years) Diagnosis IQ 140 9 Spastic quadriplegia 89 Ton-cerebral palsied children to normal schools 4 348 13 Spastic quadriplegia 77 Non-cerebral palsied children to special classes of normal 405 9 Ataxia and tremor 67 schools .. .. .. 2 603 4 Athetosis 81 Ton-cerebral palsied children to institutes for grossly retarded 688 4 Spastic quadriplegia 94 children.. 7 718 4 Paraplegia 63 Total 13 later re-admitted (Table ill). These cl;Iildren must be ex­ cluded from the survey, since they cannot yet be said to Cerebral palsied children to special classes of normal schoo~ 5 have 'left school'. Cerebral palsied children to normal schools (but doubtful if they will cope) .. ...... ". 4 Thirteen children with conditions other than cerebral Cerebral palsied children to normal schools (copmg well) 13 palsy were discharged (Table IV). Cerebral palsied children to institutes for grossly retarded children .. .............. 13 This survey, therefore, can only cover 75 children who Cerebral palsied children taken home by parents and being suffered from cerebral palsy and who left Forest Town kept there .. .. .. 14 School during the period under review. Cerebral palsied children to work 3 Cerebral palsied children to sheltered workshops . 3 In considering the question of prognosis in cerebral Cerebral palsied children to St. Vincent's School for the Deaf 3 palsy (with these 75 children who left the school as a Cerebral palsied children to epileptic school .~. 2 Cerebral palsied children too ill to treat . 4 yardstick) it must be remembered that the school does not Cerebral palsied children to Tara HospItal for NeurolOgIcal admit a completely representative group of cerebral palsied Disorders .. .. .. .. .. .. .. 2 children.l Ineducable children are refused a<j.rnission. Cerebral palsied children to vocational high school .. 6 There is also the very occasional child whose mental and Cerebral palsied children to Edith Hinds Secondary School for Retarded Children .. .. .. .. .. 2 physical disabilities are so mild that he is advised to Cerebral palsied children to technical training college 1 remain at a normal school without ever having been ad­ Initted to Forest Town School. Therefore, the picture Total 75 emerging from the figures quoted displays slightly more Of the above, 3 died and 1 was killed in a car accident. optimism than the problem actually warrants. The figures do, however, give some indication of what can u1timately * Present address: Department of Paediatrics, Baragwanath Hospital, Johannesburg. be expected of the children who have been adInitted. 24 S.A. MEDICAL JOURNAL 12 January 1963 TABLE ill. DISCHARGED AND READMITTED Age at time File No. ofdischarge Diagnosis IQ Remarks (years) 415 7 Left hemiplegia 82 Taken overseas by parents, later readmitted here 423 12 Spastic paraplegia 92 Geographic reasons, at 9 years absconded. At 11 years to normal school. Readmitted and again discharged to normal school, special class 445 5 Spastic triplegia 72 Family moved to Krugersdorp when 5 years old. Later readmitted 467 6 Left hemiplegia 105 Nursery school, then readmitted 745 3 Spastic quadriplegia • 106 Too young. Applied for readmission later 601 3 Spastic paraplegia 107 Unable to attend because of transport difficulties, but can now do so by courtesy of Uncle Ted's Fund buses 532 3 Athetoid 104 Thought to be able to cope in ordinary nursery school, but could not and returned 2 years later. High-tone deafness TABLE IVA. NON-cEREBRAL PALSIED CHilDREN TO NORMAL SCHOOLS Age at time File No. oftransfer Diagnosis IQ Remarks (years) 334 5 Emotional disturbances. Not CP· 117 Normal school 782 4 ? Muscular dystrophy and ? brain injured. 93 Nursery school Not CP 787 5 Speech defect. Not CP (Koh's blocks) 95 Normal nursery school and speech clinic (S.A. individual scale) 66 882 7 Familial dysautonomia. Not CP 135 Normal nursery school TABLE NB. NON-CEREBRAL PALSIED CHILDREN TO SPECIAL CLASSES Age at time File No. oftransfer Diagnosis IQ Remarks (years) 560 4 Todd's paralysis. Epileptic. Not CP 50 To normal nursery school. Later to special class of normal school 836 8 Partially sighted. ot CP 55 Normal school TABLE rvc. NON-CEREBRAL PALSIED CHILDREN TO INSTITUTES FOR GROSSLY RETARDED CHILDREN Age at time File No. oftransfer Diagnosis IQ Remarks (years) 293 7 Mentally deficient 28 The Hamlet--occupation centre for ineducable children 436 7 Mentally deficient 45 Normal school initially, now at The Hamlet 451 7 Mentally deficient 'Low' Special class 469 12 Psychotic 'Low' The Hamlet 536 6 Mentally deficient 32 Destination not known 789 6 Mentally deficient 54 The Hamlet 880 11 Infantile psychosis 82 Rudolph Steiner School, Pretoria • CP = Cerebral palsy. INTELLIGENCE TABLE V. DISTRIBUTION OF IQS OF CEREBRAL PALSIED CHILDREN* The intelligence of children attending Forest Town School Percentage ofthe 72 has been assessed by psychologists working full-time at Percentage ofthose CP children with Intelligence in the school at known IQ results the school (Dr. D. van Niekerk, 1956 - 1959, and Mr. J. (IQ in brackets) the end of1961 who left the school P. B. Starker,2 1959 - 1961). (124 children) permanently, The intelligence quotients (IQ) given in this review 1956-1961** represent the highest estimate calculated for each child. % % Superior (120 plus) 4 1·5 In arriving at this figure the psychologists used the South Bright average (110-119) 4 5·5 African Individual Scale, Koh's Blocks, the Merrill-Palmer Average (90-109) 24 18·0 Scale and the Vinelands Social Maturity Scale. Dull average (80-89) 18 15·25 Much experience is necessary before assessing children Borderline (65-79) 31 22·25 Defective (50-64) 15 14·0 with cerebral palsy. The psychologists performing the tests Ineducable (below 50) 4 23'5 worked full-time at the school and chose tests which • From the records of Mr. I. P. B. Starker and Dr. D. van Niekerk. allowed for each child's peculiar disabilities. RemarkablY •• The IQ of 9 CP children who left the school permanently was not similar results have been recorded independently by each recorded. of the 2 observers over the years (Table V). with the distribution of IQs of children in the school Table V compares the IQ distribution of 72 cerebral at the end of 1961.2 A higher percentage of children in palsied children who left Forest Town during 1956 - 1961 the ineducable range is noted among those who have 12 Jan~e 1963 S.A. TYDSKRIF VIR GENEESKUNDE 25 TABLE VI. TO SPECIAL CLASSES Age at time of File No. transfer Remarks (years) 133 14 Athetosis 71 Special class in Bethlehem 156 12 Spastic quadriplegia 85 School for retarded, atal 186 12 AUutia 63 Open-air school 502 12 Left hemiplegia 75 Special class in Kruger Laerskool 724 13 Athetosis. Brain injured 65 Special class in Edenvale TABLE W. TO NORMAL SCHOOLS (BUT DOUBTFUL WHETHER THEY \VILL COPE) Age at time of File No.
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