Séguin's books and the numerous special works should be consulted by the physician or parent desiring to pursue these methods to their fullest development.
When once the control of muscular movement begins to improve, more elaborate exercises may be set. In speech, if the patients be intelligent, they will sometimes be amused and profitably trained at the same time by the effort to learn and repeat long words or nonsensical combinations of difficult sounds, like the "Peter Piper" nursery rhymes.
B.M., æt. fourteen, an intelligent lad, of Jewish parentage, suffered a forceps-injury at birth, and had convulsive seizures later. He began to make futile attempts at walking when five or six years of age, when the spastic rigidity was first noticed. His speech was better at this time than later, and a sort of relapse seemed to be precipitated by a fall in which he struck his head when seven years of age. His mother, finding it almost impossible to teach him to walk, devoted herself faithfully to improving his mind, so that at fourteen years of age he read well and enjoyed books, and was mentally clear, observant, and docile. His speech was almost incomprehensible,—stuttering, thick, and nasal. He stood, swaying in every direction, though not apt to fall, with bent knees, rounded shoulders, every muscle in the extremities rigid, the mouth half-open, the head projected forward, and, upon attempting to move, the toes turned in, the legs almost twined around one another, and, unless supported, he would stumble and twist about, scarcely able to get forward at all. With a guiding hand he did a little better. His first lessons were in "setting-up drill," while the feeble, disused muscles were strengthened by massage, which served at the same time to help his very irritable and imperfect digestive apparatus, so that it was soon possible to give him a greater variety and more nourishing kinds of food than he had before been able to take. He was kept in bed up to three o'clock in the afternoon, the morning hours occupied with massage and a half-hour's lesson in erect standing, with slow trunk movements afterwards. An hour after dinner he was dressed and taken for two hours in a carriage or street-car. He did his reading and some study on his return, and had another half-hour's drill, superintended by his mother. In two or three weeks some improvement began to be observable in his attitude, and a great change in his color and general expression, but it was three months before it was thought wise to attempt education in small co-ordinate movements. At about the same time speech-drill was commenced.
In all these lessons the greatest care was taken that adequate rest should intervene between each series of efforts, and it was always found that fatigue distinctly impaired his co-ordination, as did emotion or indigestion. When his speech grew clearer he was set tasks of learning many-syllabled words and also began to practise drawing patterns. Every new lesson was first given under medical supervision and then continued by his mother or by the masseur. To shorten the history it will suffice to say that in six months he was able to go to school, where with certain allowances made for his thick speech by a kindly master he did well, and returned to his home in the South able to walk without attracting attention, to speak comprehensibly, to write a good letter, and with every prospect fair for a still greater improvement, which I learn he has since made.
The important things to be recognized in the treatment of these cases are, first, that rest in proper proportion allows of the patients doing an amount of exertion which, ungoverned, or performed in wrong ways would harm them; secondly, that full feeding is of value, because these disorders are mostly of the character of degenerations and involve failure of nutrition in various directions; and, lastly, that the exactness of routine is of the highest moral and mental as well as physical importance.
Paralysis agitans needs scarcely more than to be mentioned as amenable to the same methods, with small differences in the application of details. Body movements to counteract the tendency to rigidity in the flexor groups of spinal muscles will be especially useful, as the stiffness of these is one of the causes of displacement forward of the centre of gravity, a displacement which results in the festination symptom usually seen in such cases. Prescriptions of special exercises for the muscle-masses particularly involved in each instance must be given, remembering that contraction of the affected muscles will to a certain degree overcome their rigidity even at first, and to a still greater extent as the patient reacquires voluntary control.