A STUDY OP THE OCCUPATIONAL THERAPY PROGRAM OF AIDMORS CONVALESCENT HOME
ATLANTA, GEORGIA
A THESIS SUBMITTED TO THE FACULTY OF THE ATLANTA UNIVERSITY SCHOOL OF SOCIAL WORK IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK
BY THEODOSIA RUSSELL JOHNSTON
ATLANTA, GEORGIA AUGUST 1948 il TABLE OF CONTENTS
Chapter Page I. INTRODUCTION 1 Purpose of this Study 4 Scope 4 Method of Procedure 4 II. THE HISTORY AND DEVELOPMENT OF OCCUPATIONAL THERAPY.. 5
III. THE HISTORY AND DEVELOPMENT OF AIDMORE 13 IV. THE OCCUPATIONAL THERAPY PROGRAM OF AIDMORE 21 V. SUMMARY AND CONCLUSION 31 APPENDIX 35 Schedule • 3 6
BIBLIOGRAPHY 38 CHAPTER I
INTRODUCTION
"An organic disability becomes an actual disability only when the individual senses a defect and feels a consciousness of that defect reflected in his environment."^
If we look around us, we see many fine persons who have some physical handicap which we fail to note after a first
acquaintance because their engaging personalities erase their physiques from our minds. If we acquaint ourselves with the childhood of these individuals, we would perhaps find that they as children received the kind of love, attention and understanding which enabled them to take advantage of opportunities and substitute for handicaps. At one time or another, most normal children go through a period when they feel lonely, bitter and suspicious because of physical attributes which make them appear different from other children - a long nose, chubbiness, gawkiness or large
ears. The personalities of these children are not permanently damaged, however, because these handicaps are not sufficient
to cause continuous frustration, or because the children, in time, acquire a sense of values in which slight differences
do not matter.2
^Georgia Ball, "Case Work With Crippled Children," The Family. XX (April, 1939), 267. 2 Ibid. 1 2 The sense of difference which the crippled child feels and the loneliness which he may experience are liable to result in a serious maladjustment of the personality if he is not given the type of understanding to which all children are entitled. An element of very great importance in all Institutions where crippled children are cared for is the general atmosphere. Recovery for many of these patients who have suffered much pain, is dependent upon their states of mind. It is because of this that modern, properly conducted orthopedic schools, convalescent homes, hospitals or sanita¬ riums have the atmosphere of hope, good will, cheery laughter and essential comfort. In addition to sunlight, fresh air and general pleasant surroundings, toys, amusement books, companionship and instruction in occupational therapy is available to the greatest possible degree. Here the child is furnished with companions of his own age and able to compete with him in games and sports as adequately as his handicap will permit. As a result, during these years of his life, rarely reminded of his handicap, the child develops a healthy normal psychology.^ The instruction provided in the various occupational and recreational arts have physical as well as vocational value. It trains one in the use of muscles which might otherwise remain dormant. Some of the industries which these children may
■^Henry Abt, The Care, Cure and Education of Crippled Children (Ohio, 1926), p. 45. 3 be instructed in are sewing, lace making, chair caning, burnt woodwork, knitting, crocheting, leather work, basketry, making artificial flowers and pottery. Recreational activities may include folk dancing, checkers, lasso-throwing, marbles, shuffle-board and pitching horse-shoes. All activity must be approved by a qualified physician. The spastic, who lacks control of normally voluntary muscles, receives more than mere happiness from playing with blocks or stretching the cord on a shuttle. In addition to assurance that he can play like other children, he is being taught to grasp: he is developing muscular coordination. The girl whose leg is withered as a result of infantile paralysis and who cannot walk because of a contracted tendon at the back of her heel is having that tendon stretched by operating the pedals on the weaving machine.^ As a result of the intrusion of occupational and recreational therapy in the programs of institutions for crippled children, "pallid frail children find themselves becoming robust and delight in using their new found strength and muscular power in games and contests in which they believed they would never be able to engage."1 2
Moreover, these practices, like surgery and physiotherapy, have become a necessary part of the regimen of the better
1Ibid., p. 46.
2Ibid. 4 institutions for crippled children all over the country.
Purpose of the Study
This study has undertaken to analyze the extent to which occupational and recreational activities are used by Aidmore, how effective they have been in giving to the children emotional as well as physical relief and the areas in which they have proved least effective.
Scope Consideration has been given the physical equipment, the provisions for education and organized recreation, and the attitudes of the therapists with regard to the program during the year 1948.
Method of Procedure
Visits were made to the institution for purposes of observation and interviewing members of the institutional staff. Schedules were employed in the latter instance. Pertinent literature was perused. CHAPTER II
THE HISTORY AND DEVELOPMENT OF OCCUPATIONAL THERAPY
Occupational therapy as such is still a relatively new profession. "in 172 A. D. the Greek philosopher Galen made the statement, ’employment is nature's best physician and is essential to human happiness.'"1 For hundreds of years physicians have acknowledged the benefit of the employment of arts and crafts for the diversion of the sick. It has been variously called "work cure," "ergotherapy," and "diversional occupation." Only during the past decade has it taken its place as a definite form of medical treatment, like drugs, diet, or massage, prescribed by a doctor and administered by a specialist. Not until 1914 was it called occupational therapy.2
Susan Tacy in 1910 published a book on invalid occupations designed for the instruction of nurses, but despite the fact that it embodied many principles followed today it contained no hint that it might, at any time, engage specialists in its •3 application.
‘'"Edith M. Stern, "The Work Cure," Survey Graphic Magazine, XXVIII (April, 1939), 282.
2Ibid.
3Ibid. 5 6 The United States is really a pioneer in the field of occupational therapy. The term was first used by Dr. George E.
Barton at a conference of social workers in 1914- but at the time caused no real sensation in the medical world. In 1908, the Chicago School of Civics and Philanthropy offered a course for the training of occupational therapists in the care of the mentally ill. Prior to that time the same school had given occupational training to nurses as a sideline, but their training was not as adequate as it is today and many of the trained had little technical knowledge*^ The actual birth of occupational therapy as a profession occurred very suddenly in 1918, when the A. E. F. sent out a call for women workers to provide bedside occupation for sick and wounded soldiers. As a result, the Walter Reed hospital published monographs with charts showing patients' improvement after workshop. From that time on, the prophecy of Dr. Thomas
W. Salmon, chief consultant in Psychiatry in the A. E. F., has begun to be fulfilled step by step. He stated that, "someday, occupational therapy will rank with anesthesia in taking the suffering out of sickness and with anti-toxin in shortening its duration."2 Another great stimulus towards the growth of the profession was provided by the depression which followed the war, when work-starved hands found comfort in the crafts
^Ibld., p. 285.
2Ibid. 7 and other therapeutic arts. The recognition of occupational therapy as one of the valuable skills of medical science brought about the establishment of many training schools in various sections of the country. Now the American Association of Occupational
Therapists stands guard, so that 0. T. R. (Registered Occupational Therapist) carries with it the same kind of guarantee as R. N. (Registered Nurse).1
Occupational Therapy is a type of medical treatment that must be prescribed by the physician according to the needs of the patient. Physically its function is to increase muscle strength and to improve the general bodily health; mentally its function is to supply, as nearly as possible, normal activity through vocational projects and pre-vocational studies and training. A given regimen of occupational therapy must be prescribed by an orthopedic physician and its progress watched and guided by the therapist, who is well versed in 2 methods and procedures. The tenm "occupational therapy" and "occupational rehabilitation" are often confused. Although they do sometimes overlap, each is a separate and distinct service. The former aims simply to "occupy the patient with some sort of task that
1Ibld. p Helen S. Willard, "Occupational Therapy - A Relatively New Profession," Occupations, The Vocational Guidance Magazine, XVII (January, 1939),293. 8 will aid in restoring him to health."^
Thus it does not have a vocational significance, although pre-vocational training may be part of the therapist's duties. Occupational rehabilitation, on the other hand, is the "work of adapting and training the handicapped person for an occupation in which he may be able to earn a living."2 jn occupational therapy, corrective, remedial treatment is the primary motive; in occupational rehabilitation, the aim is to prepare the patient for a renumerative vocation.
As distinguished from physiotherapy, the chief difference lies in the techniques. "The occupational therapist must be thoroughly skilled in arts, crafts and other therapeutic activities. The physiotherapist must be skilled in massage and the method of treatment by heat, lights, water and electricity"
The occupational therapist must mentally stimulate and guide the patient into actively taking part in some industrial activity or mechanical means, suited to the individual case, to produce marked changes, stimulate nerves and muscles or act as 4 a corrective exercise to hasten recovery.
1Ibid.
2Ibid.
^The Institute For Research, Occupational Therapy As A Career, University of Chicago Press, 194-0, p. 1. 4 Ibid. 9 Today, if you walk into the workshop of a childrens
hospital, except for the fact that some of the youngsters have
obvious handicaps, your first reaction would be that you have
strayed into a nursery schoolroom. Instead of the usual
paraphernalia, you would see weaving machines and other
equipment used in the program of occupational therapy.
"The therapist in charge is as much a skilled medical specialist as a dietician, a laboratory technician or a nurse. The children's occupation and recreation is as carefully measured and selected as the braces which some of them wear.l A large part of the therapist's job is the selection of occupations and recreation suitable to temperaments and emotional quirks as well as to physical needs. Because of this, psychology and the ability to handle people is just as important as a knowledge of kinesiology (muscular activity)."2
Occupational therapy includes anything from arts and
crafts to recreational activities, like games, folk dancing
and dramatics or such educational pursuits as round the world
trips via travel folders or stamp collections. There is no
set rule which must be followed by the therapist in
capturing the interest of his patients.
Equipment most useful in helping the patients to gain the use of disused members and strengthen and coordinate muscles
includes rugframes, treadle and electric sewing machines,
metal frames to be used in knitting, scroll saws with
adjustable seats and pedals, power saws and wood working
■'‘Edith M. Stern, ojo. clt., p. 282.
2Ibid. 10 benches with a supply of tools. Handicraft represents a form of therapy high in sensory value. It helps the individual to come in close contact with reality. Increasing one's motor control through such pleasurable activities naturally has a tendency to increase one's feeling of capacity. Because crafts have their dangers as well as their use, the therapist must learn what to avoid as well as what to use.
For example, patients suffering from tuberculosis or bronchial disease are never allowed to work with carving or jewelry making because the inhalation of metal or wood particles aggravates the condition.^ 2 "Play is the work of childhood." It should be recognized that because a physically handicapped child is, except for his handicap, as normal as any other child, he should be given the same opportunities for development through recreation to which all children are entitled. The crippled child, like the normal child, needs recreation not only for amusement but so that he may learn the basic rules for living together - giving and taking, becoming socialized. "Recreation aims to (l) improve the leisure of the handicapped (2) help him to realize and maintain his degree of physical adjustment and (3) help him to keep
1 Ibid. 2 Eleanor C. Dobbins and Ruth Abernathy, Physical Education Activities For Handicapped Children (New York, 1936), p. 7. 11 a wholesome, emotional outlook on life."^ Examples of special recreation in certain cases are the following: (a) Nursery orchestras - Effective in developing muscular coordination and in stimulating success in the cases of those children suffering from spastic paralysis, (b) Dances - Effective because they offer passive stretching, which is treatment for the clubfoot afflicted, (c) Games - Effective in the treatment of those patients who are victims of structural
scoliosis because they are designed to establish symmetry. In the 19th century, Virchow made the statement that "not the disease but the man must be treated." Recognizing the truth of this statement and realizing that the mental and physical work together, doctors confine much of their treatment to working with the emotions. It is impossible to determine exactly to what extent improved spirits, resulting from directed outside interest, affects blood circulation and general well being of the patient, or to what extent it helps to lessen aches and pains. However, doctors agree that the happy, well-contented patient tends to get well faster than 2 the disgruntled and depressed. Very often, doctors prescribe occupational and recreational therapy with no other remedial purpose in mind except diversion - to relieve the sense of frustration, the feelings
1Ibid.
2 Edith M. Stern, 0£. clt., p. 283. 12 of helplessness, and the rebellion against fate which, In many- handicapped persons, Interferes with their normal activity.^
A recent survey made for the Boston School of Occupational Therapy revealed that, of the 6,189 approved hospitals of all types listed in the 1937 report of the American Medical Association on hospital service in the United States, only thirteen per cent employed occupational therapists. The vast majority are employed in New England, New York and Pennsylvania, but there is a steady increase in the number being employed in the West and South. In addition, departments of occupational therapy have been established in Hawaii, Puerto Rico, Canada, p England, Scotland, Sweden, Denmark, India and Australia.
There is scope for a wide range of interest and abilities in occupational therapy because of the varities of recreational, vocational and industrial activities which it includes. Although the profession is still in its infancy, the fact that it is being accepted is evidenced by its rapid growth and by the fact that the demand far exceeds the supply.
1Ibid«
2Helen S. Willard, op. clt., p. 296. CHAPTER III
THE HISTORY AND DEVELOPMENT OF AIDMORE
The decision to form an organization dedicated to the
service of the physically handicapped children of Georgia was first made when five Elks met in the home of Atlanta Lodge No. 78 in October, 1937» The actual need for a convalescent home for crippled children was brought to the attention of these Elks by Martin T. Meyers, Director of the Orthopedic Division of the Georgia State Department of Public Welfare. Mr. Meyers informed them that, although 400 children had received corrective treatment during the first six months of the welfare program, their physical restoration was retarded by the lack of convalescent care. Almost immediately, the five men who attended the meeting began to draw up a plan for the organization of a convalescent home and to make plans for incorporating the
Crippled Children League of Georgia.^" The Crippled Children League is:
A charitable, non-profit organization with broad powers to solicit contributions, buy and sell real estate and other properties and to perform all functions necessary to the administration of the organization's wide chari¬ table program.2
•*~Aidmore (Crippled Children League of Georgia Publication), Dec ember, 19^7, p. 10.
2Rose Phillips, "A Study of Aidmore Convalescent Home - A Community Resource for Crippled Children in Atlanta, Georgia" (Unpublished Master's thesis, School of Social Work, Atlanta University, 1947), p. 30. 13 14 Many children who are considered ineligible for service by the Crippled Children Division of Georgia are rendered services by the League. It was founded in New York in 1868. There are 1,400 surbordinate Lodges in the United States and its possessions, with a membership of more than 500,000. They own property and cash to the extent of over $74,000,000, and annual disbursements for charitable and welfare work are never less than $1,000,000.1 The Elks applied for a license for their organization on January 14, 1938, but were denied it because the petition specified "white crippled children." This phrase was deleted, however, and, on February 4, 1938, the organization was incorporated under the Crippled Children League of Georgia. Soon after this, the League was accepted into the National Society for Crippled Children. Membership gave the local organization benefit of the national organization's wide and varied experience in the field of service to physically handicapped youth and participation in the national fund 2 raising campaign through the sale of Easter seals. The League defines a crippled child as "one between the ages of birth and twenty-one years, whose bone, joint or muscular function is so restricted as to limit its possibilities of normal development - physically, socially
^""Benevolent and Protective Order of Elks," Encyclopedia Americana (New York, 1945)» 25.
^Rose Phillips, op. cit., p. 2. 15 or economically."^ Its program includes (l) the study and need of crippled children of Georgia and facilities available for treatment and care; cooperation with similar institutions and hospitals, both public and private, in a full program providing adequate means of locating afflicted children and subsequently providing proper medical examination, hospitalization, education and guidance; (2) organization and development of county and community committees to serve as units in a state-wide program for the advancement and welfare of afflicted children and, wherever possible, in behalf of crippled adults; (3) to furnish all established units such direction, assistance and support, financially or otherwise, necessary to 2 conformance with the League's Inclusive program.
In addition to providing for the support and maintenance of Aidmore, the League renders such services as operating clinics, conducted in cooperation with the Public Wqlfare Department. It also finances patients' travel to various clinics throughout the state, specialist treatment, surgery and appliances. In February of 1939, the Crippled Children League adopted resolutions for establishing and maintaining a convalescent home for the crippled children of Georgia. The State
Department of Public Welfare proposed that the Elks assume
Aidmore, op. cit«
2 Rose Phillips, OJD. cit. 16 control of a Convalescent Home located at 3784 Peachtree Road,
Atlanta. The League advanced a sum of $1,100.00 for the purchase of equipment owned by the Home. Title was acquired and responsibility assumed.1
As soon as Mr. Robertson, the first superintendent named by the League, took over the operation of the Home, steps were
taken to improve the working and living conditions of the nurses. A competent dietician was employed. A contest was held with the idea of getting a descriptive, distinctive name for the institution. It was limited to youth under twenty-one years of age, and cash prizes were offered for the five best names submitted. "Aidmore" was selected by the judges because "it adequately expressed the worthy purpose of the Elks to 2 give more and more aid to more crippled children."
Zoning restrictions against institutions and convalescent homes forced the League to search for a new location for the Home in September, 1941. This was, at first, a rather difficult problem, because most residential neighborhoods are zoned against institutions. After a period of seven months, the committee appointed to consider means for meeting the
need, recommended the purchase of the "Little Property," located at 918 Peachtree street. The property consisted of
a lot and two residences. One residence was composed of
1Ibld.
O Aidmore, op. clt. 17 twenty-six rooms; the other, eleven.
The main residence serves as quarters for the fifty patients, the nurses' rooms, the physiotherapy department, the medical examination room, the offices of the superintendents, the food dispensary, the kitchen and the service pantry. The office of the Crippled Children Division of Georgia is located in the First Annex, which also provides eighteen beds for patients. The Second Annex, located in the rear, houses the Occupational Therapy Department, the office of the therapist, the schoolrooms and the clinics. Aidmore comprises a Medical Department, a Nursing
Department, a Dental Department, a Physiotherapy Department, an Occupational Therapy Department, and clinics. There are eleven wards, ten divided on the basis of age and sex, and one an isolation ward, for children who need to be separated from the group because of a contagious disease. There are no 2 private rooms. The staff of Aidmore is composed of a superintendent, a
pediatrician, nine graduate nurses, thirteen nurses' aides, a registered occupational therapist, a recreational director, two teachers, a dietician, one cook, four orderlies, three porters and a yard man. Orthopedic surgeons from various hospitals in Atlanta volunteer to assist the one
1Ibid.
2Rose Phillips, op. clt. 18 orthopedic surgeon on the staff a certain number of hours per week. They give periodic check-ups and make recommendations for physical and occupational therapy. It is the duty of the superintendent to direct the institution, select the staff, and handle such matters as general purchasing and repairing. He is directly responsible to the president of the Crippled Children League.
The pediatrician examines the patients on admission and subsequently as condition requires. The physiotherapy department consists of two rooms and such equipment as treatment tables, walking ramps, diathermy lamps, a whirlpool, a portable underwater therapy tank and ultra-violet lamp. The physiotherapist performs such duties as giving massages, hot packs and assistance to children learning to walk, directing corrective exercises, and diathermy and ultra-violet treatments as prescribed by the attending physician. In addition, the therapist gives showers, adjusts protective appliances, measures crutches and teaches patients to use them. The occupational therapist works under the physician by giving patients the types of occupational and recreational therapy prescribed. Both Negro and white patients from all over the state of Georgia attend the clinics on special days. These patients do not receive occupational therapy. 19 Children are referred to Aldmore from three sources - the Crippled Children Division of the Department of Public Welfare, private physicians, and hospital social service depart¬ ments throughout the state. Admission is limited to white children, twenty-one years of age and under, in need of convalescent care. There is no limitation to the type of crippling condition, although the majority of the patients seem to have plastic and orthopedic disorders. Length of convalescence may range from one day to a period of years.
The leading cause of crippling among patients at Aidmore is cerebral paralysis, a condition resulting from damage to certain portions of the brain. These are divided into three groups - (1) spasticity, (2) antheosis, and (3) ataxia. The
second largest group suffers from clubfeet; the third group from infantile paralysis; and the fourth group from tuberculosis 2 of the bone and joints. Inadequate facilities make it- impossible for the program of Aidmore to be developed to maximum effectiveness. The
increasing demands, which become greater year by year, have made it necessary for the Crippled Children League to
consider plans for expansion of the home and its program. Plans have been drawn up for a larger Aidmore, approximating three acres. Its capacity will provide for one hundred additional beds with necessary adjunct
^"Statement by Mr. Russell, Recreation Director, Aidmore Convalescent Home, Atlanta, Georgia, personal interview, April 3, 1948.
2Ibid. 20 departments and facilities. A separate section will be provided for Negro children comprosed of thirty-five beds and separate department.^
1 Aidmore, op. cit. CHAPTER IV
THE OCCUPATIONAL THERAPY PROGRAM OF AIDMORE
The program of occupational therapy at Aidmore is based on the specifications of the International Society for
Crippled Children (the "Crippled Child's Bill of Rights") all of which are summed up in the tenth paragraph:
In brief, not only for its own sake, but for the benefit of society as a whole, every crippled child has the right to the best body which modern science can help it to secure; the best mind which modern education can provide; the best position in life which its physical condition, perfected as best it may be, will permit, and the best opportunity for spiritual development which its environment affords.
It is the aim of the department "to speed recovery, confidence and self reliance by putting the minds and muscles to work and to provide proper education through instruction, bedside and other wise."^
The program includes training in the various occupational and recreational arts and in academic subjects.
The educational training is set up according to curriculum
standards of the Department of Education of the State. It
is supervised by a registered occupational therapist, who is directly responsible to the superintendent of the institution and who plans the program according to instructions given him by the staff physicians.
Others who work with the therapist in administering the
1 Aidmore, op. cit. 21 22 program are a recreational director and two teachers. Sometimes, volunteer workers give temporary assistance in carrying out the program. Of the seventy patients hospitalized at Aldmore in 194-7, approximately sixty were given benefit of this program. They ranged in age from one to twenty-one years of age and were classified according to their aptitudes, abilities and capabilities. Physicians did not prescribe treatment for the patients. Instead, they sent to the therapist detailed reports of the individual case. These reports included the causes of disability, the length of time the patient had been handicapped, the degree to which the patient's life had differed from that of the normal child, what muscles needed to be strengthened, and the amount of rest which the patient required. Upon admission, the therapist studied the patient for two days before making out a schedule for the type of training which he was to receive. Because it was necessary for the therapist to note the extent of the patient's emotional injury, if any, as well as his physical injury, it was important that he have an elementary knowledge of child psychology as well as a knowledge of the occupational arts. The two teachers at Aidmore were carefully selected and placed in the institution by the State Department of Education and were paid by the same. A volunteer teacher was first interviewed by the therapist and then referred to 23 one of the two teachers, who acquainted him with the educational phase of the program. The same procedure was followed in the selection of volunteer workers in other connections. In the education of crippled children, problems which do not appear in ordinary educational systems are more than apt to occur. Both the curable and the incurable children are taught in the same class rooms. Those who are incurable, or whose cure is possible only after years of treatment, need a system of education which will uniquely develop their abilities. The teachers have to deal with some children who are familiar with school routine and with others who have never been able to attend any school or to associate freely with other children. Also present are the emotional components of problems in children in early adolescence. The task of these teachers is, therefore, a tremendous one and requires much understanding and skill. They attempt to give each child very close attention and are eager to have those students who leave to re-enter regular school do so in the grade for they would be suited normally.
The curriculum was modeled after that in public school classes, although the hours were shorter. The program was so organized that the younger children attended classes in the morning, from ten to twelve, while the more advanced students attended classes in the afternoon, from two to four. This was done to avoid fatigue, overburdening, overly 24 challenging experiences and over-crowding of classrooms. Classes were held in the two classrooms of the annex. Equipment in these rooms was modeled after that of the regular public schools. One classroom was complete with small chairs and tables, instead of desks, because patients were better able to relax in these. In addition, there were blackboards, visual aids and kindergarten materials. The other classroom, geared to care for children of upper grammar and high school age, was larger and complete with maps, globes and other paraphernalia of more advanced students. A limited library was located in the corridors of the buildings. The books found there were those written especially for children and included both fiction and non-fiction. The occupational and recreational directors, like the teachers, were well-versed in the treatment of emotional disturbances which children may suffer as a result of the attitudes of others toward their disabilities. Recognizing that trades which are suitable for children with some kinds of handicaps are quite impracticable for those who are crippled in other ways, the therapist must always ask himself the questions; Can this particular child do this work? Can this particular child play this game? Will this activity meet the needs of this patient? Like that of the teachers, the tasks of the therapist and the recreational directors were tremendous ones. They had to be on hand constantly, guiding and directing, selecting the 25 right materials for patients to work with, and watching for signs of fatigue, such as sighing or diminished progress* The therapist studied what was happening to the patient as well as what was happening to the material which was being fabricated into an object, ) The recreational director concentrated on what the game was doing for the patient as well as his ability to play and his knowledge of the game. The workshop was about twice the size of the largest classroom, and the equipment found there included the usual bicycle saws, ruglooms, an electric sewing machine, woodworking benches, a complete set of tools, building blocks and weaving looms. The workshop was not merely a playroom, although the children seem to consider it thus. Every device found there was selected as a curative for some specific disease. The large crayon used in drawing or coloring was valuable for the development of muscular coordination.
Spastlcs gained strength and control of voluntary muscles as a result of stretching the thread from a nail on one side of the handloom to a nail on the other side, a distance of perhaps eight inches. Wheel-weaving with a child in a fixed position developed shoulder and elbow motions. The bicycle saw developed the knee, the leg, the ankle and the foot. It was often used to strengthen and develop 26 legs withered as a result of infantile paralysis.
Equipment found in the workshop was designed to suit various cases. There was the machine which produced a simple braid, designed to be handled by the very small child, and there was the machine which was complicated enough and which
produced a pattern complex enough to keep a chronic patient absorbed day after day. The therapist, in treating the emotions, considered the choices of the colors of thread which the patient used. Will it make him nervous? How long will a design of this sort hold his interest? How would I react if I were not feeling well. He also considered the positions of the instruments being used by the patient. A patient whose abdomen is thrust forward by a malformation of her hip bones must have her loom at precisely the correct height to make her assume
a corrective position. Two inches higher or lower would do more harm than good. The therapist had to be alert, shifting the positions of some of the children so that their saws would not injure the patient next to him. The recreational department was not a very extensive \ one. The director concerned himself with conducting simple exercises which are effective in stretching and strengthening muscles and in supervising organized play
which helped the patients to develop socially.
Such activities as Jigsaw and other puzzles, Chinese
checkers, radio programs, movies, recorded music, reading, 27 building and construction games were used indoors.
The patients reveled in their ability to engage in such sports as tossing a ball, sometimes batting a ball, and pitching horse shoes outdoors, just as normal children do.
The use of some of the older handicapped children as assistants to the recreational director encouraged them to acquire skill.
Maintenance tasks were not required of patients except in cases of high school students who were given training equivalent to the courses in the home economics and manual arts offered by most high schools. Girls were allowed to assist the domestic staff. This included setting the table, dusting, dish drying, etc. The boys engaged in the repairing of wheel chairs and machinery used by the institution.
In addition to the program staff and its volunteer workers, two volunteer groups worked with the patients once a week. A group from the Napsonian School^" visited the institution every Wednesday afternoon to engage in recreational activities with the patients who were not confined to beds and to read to those who were bed-ridden.
One night a week, some local church group conducted a community song service with the patients. A few of the boys were directly affiliated with the Boy Scouts or with the
Y. M. C. A.
‘A private^ Presbyterian church secondary school, for girls 28 The program of Aidmore had serious limitations:
1. The program failed to include patients who attend clinics. Thus, Negro children did not receive occupational therapy. 2. The classrooms were overcrowded.
3. There were only two teachers in the educational phase of the program. 4. There was need for more trained therapists and recreational assistants.
5. There should be more space for activities, occupational and indoor-recreational as well. 6. There was need for a social service department, which would serve to reach cases who would receive proper care unless they were sought out, and supplement, through case work services, the functions of other departments. Evidence of the effectiveness of the program, however, despite its limitations, was the cheery atmosphere. There was a surprising degree of quasi-normality due to the high character of the program staff and their skill in relating to the children. The patients are cheerful, courageous and enthusiastic and appeared eager to measure up to the accomplishments of normal children and to engage in games, education and sports which would, in time, help them to become independent citizens. Two recent examples of the effectiveness of the program were victims of spastic paralysis, who, six months ago, found it impossible to control any of their movements and who today are self- propelled and have learned to speak well. This was true of many of the cases. 29 Because the chief problem of the program was that of a lack of space and facilities, plans have been made for develop¬ ing a more extensive program. They have been drawn up to consist of two workshops, four classrooms, and three sun-decks for recreational activities. A separate department has been contemplated for Negroes. Along with these plans has gone the hope for additional staff members and as a result, more organized activity and individual consideration.
Included in the additional staff members should be a medical social worker whose responsibility would be that of working with the patient's attitudes toward their disabilities.
The social worker would understand-
Y/hat defect means to the child, the accent on differences from other children, the loss of status in the home and school, the feeling of not being wanted, of feeling oneself a burden, of feeling inferior to whole children.^
In the program of occupational therapy, the social worker would supplement the work of the therapists, recreational directors and teachers by working with the treatment of the emotional handicaps and the interpretation of patients' behavior and behavior problems.
The role of the social worker in interpreting would not end with the institution but would be extended to families of the patients. She would be able to give to the parents a clear and definite picture of the patient's handicaps,
1 Georgia Ball, op. clt,, p. 56. 30 their limitations, their potentialities and their emotional status. She would he able to help them to face the reality of the situation CHAPTER V
SUMMARY AND CONCLUSION
An attempt has been made to examine, within limits, the occupational therapy program of the Aidmore Convalescent Home of Atlanta, Georgia. The study has revealed certain needs within the scheme of services being provided by the institution and has thrown some light on the relationship of the problems of physical disability to society. It has been necessary to look into the growth and development of occupational therapy as a profession, to discover its aims, purposes and scope. Essentially, the profession has to do with the social adjustment of the child. It may include in its application any activity from simple handicrafts and games to complicated manual and recreational arts. The chief aim of the profession is to provide for the crippled child optimal opportunity for socialization and for helping him prove to himself and to others that there is something socially significant which he can do. Consideration has been given to the history and development of Aidmore Convalescent Home. The Institution is approximately eleven years old and although it is impossible at present for it to care for all of the cases which it would like to include in its program, evidence of progress may be seen in a comparison of its program of today with that
31 32 of yesterday. It started out as a mere hope shared by five Elks who met in Atlanta Lodge No. 78 in the year 1937. Since then, it has become an institution with adequate facilities for hospitalizing and caring for seventy patients and conducting clinical services for children from all over the state of Georgia. It has been Incorporated into the program of the Crippled Children League of Georgia. The occupational therapy program of Aidmore is limited to the hospitalized patients of the Institution. It is supervised by a registered occupational therapist, who is assisted by a trained recreational director, two teachers and volunteer workers. It is divided into three phases, (l) educational, (2) occupational, and (3) recreational. The teachers are placed in the institution by the State
Department of Education and are paid by the same. The curriculum is modeled, as nearly as possible, after that of the public school system. There are two classrooms. One is set up to care for children of kindergarten and early grammar school years, while the other is complete with paraphernalia necessary for the education of later grammar and high school ages. Serious overcrowding of classrooms is modified somewhat by a program which provides for the younger group to receive education while the older group works in the workshop and vice versa. A limited library is located
in the corridor and contains a limited supply of children's books, fiction and non-fiction. 33 The workshop is about twice the size of the classroom and during working hours is usually crowded to capacity. The equipment found here are the bicycle saw, the electric sewing machine, a rug loom, small hand weaving machines, etc. Each is designed for aiding and abetting a specific handicap. The bicycle saw is used to strengthen arms, legs and shoulders; the weaving machines, to develop muscular coordination; and the looms to foster control of voluntary muscles. Even the large crayon is valuable in giving the individual an exercise which serves to stretch and develop muscles of the arms. The therapist's job is one which requires constant alertness. He must carefully select the right type of work for certain individuals, taking into consideration not only the physical handicap but the emotional disturbance which may be its concomitant. The recreational phase of the program is not an extensive one. The director concentrates on developing and strengthening muscles by using simple exercises and games. Such games as checkers, puzzles, construction sets and marbles are used indoors, while outdoors the patients engage in tossing balls, batting, pitching horseshoes, etc. The chief limitation of the program was a lack of space and an Inability to care for all of the children receiving medical treatment at the institution. Those who attended the clinics and were not confined to the institution, were not given benefit of the occupational therapy program. Other 34 limitations of the program were an inadequate staff and the lack of a social service department. The need for a medical social worker may be summed up as follows: 1. To aid in the interpretation of behavior problems to- 4 (a) staff members, (b) the patient, (c) parents of the patient. 2. To recommend intensive psychiatric treatment when necessary. APPENDIX 36
SCHEDULE
1. Who directs the Occupational Therapy program of Aidmore? ( ) Nurse () Social Worker () Occupational Therapist () Teacher () Volunteers
11. How may assistants to the director are there? 111. Number of children being cared for at present. () Hospitalized () 0. P. D. IV. Are Negro children included in the Occupational Therapy program? V. What are the age limits of the patients Included in the program? VI. Does the institution provide facilities for Academic training? a. What is the nature of this training? b. How many teachers are there? c. How are they secured? d. Who pays them? VII. How much time is set aside for occupational and recreational activities? a. What type of equipment is used in carrying out these activities?
b. What activities are offered under the program? 37 c. How are children selected for the activities?
d. Do physicians prescribe definite activities for certain handicaps?
e. What are some of the handicaps? The activities used in treating them?
Handicaps Treatment
VIII. Is music offered as a part of your therapeutic program?
IX. Have there been instances when organized groups have visited the hospital to work and play with patients?
a. How was this carried out?
X. Are any of your patients affiliated with the Scout troops? Y.M.C.A? Y.W.C.A.?
XI. What is your opinion of the value of occupational therapy? BIBLIOGRAPHY
Books Abt, Henry E. The Care, Cure and Education of Crippled Children. Elyria, Ohio: The International Society for Crippled Children, 1924. Davis, John E. Principles and Practices of Rehabilitation, New York: A. S. Barnes and Co., Inc., 1929. Hathaway, Marion. The Young Cripple and His Job. Chicago: University of Chicago Press, 1928.
Miscellaneous Material Abernathy, Ruth and Dobbins, Eleanor C. Physical Education Activities for Handicapped Children. New York: Columbia University Press, 1939* Aldmore. Atlanta, Georgia: The Darby Printing Company, 1947* Occupational Therapy As A Career. Chicago: University of Chicago Press, 194-0.
Articles Ball, Georgia. "Case Y/ork with Crippled Children," The Family, XX (April, 1939), 267.
"Benevolent and Protective Order of Elks," Encyclopedia Americana. 14th ed. XII, 25. Stern, Edith M. "The Work Cure," Survey Graphic Magazine, XVIII (April, 1939), 282-283. Willard, Helen S. "Occupational Therapy - A New Profession," Occupations, The Vocational Guidance Magazine, XVIl‘(January, 1939), 293.
Unpublished Material
Phillips, Rose. "A Study of Aldmore Convalescent Home - A Community Resource for Crippled Children in Atlanta, Georgia." Unpublished Master's thesis, School of Social Work, Atlanta University, 1947* 38