Help for Spastics

Because of a brain injury at birth, an eight-year-old boy had never been able to sit or stand. Three months ago he entered Dr. Herman Rabat's grey clapboard house in Washington--for treatments combining physical therapy with a drug called pro-stigmine. Last week the boy walked.

Since last winter when young (33), heavy-set Dr. Kabat began treating such spastic cases, as a Saturday afternoon sideline in his front parlor, his clinic has grown until it now takes all his time. His eight therapists and 50 patients have crowded his wife and three children right out of the house.

New Habit Patterns. Spastics, or victims of "cerebral palsy," are one of the biggest and most neglected groups of handicapped U.S. citizens. Some 300,000 of them are under 21. The cause of their trouble: an injury, usually at birth or in infancy, of the motor areas of the brain, which thus lose part of their control over the nervous system. Symptoms range from the extreme of complete idiocy to slight difficulty in speech or movement.

Dr. Kabat is convinced that most spastics can be helped (although curing them is impossible). He first got on the track of spastic therapy when he worked with Sister Elizabeth Kenny (see below) at the University of Minnesota in 1942. Kabat, a boy wonder who got his Ph.D. from Northwestern at 22, was then an instructor in physiology. He discovered that prostigmine, which had been used chiefly to relieve post-operational gas pains, relieved muscular and nervous tension in polio victims, helped physical therapy to create new habit patterns.

Fascinated by the discovery, Kabat got himself an M.D. so that he could better pursue his study of paralysis. Last year, while working in Washington on polio cases in U.S. Public Health Service hospitals, he gradually realized that the treatment of spastics was no less urgent.

Prostigmine & Education. The aim of spastic therapy, Dr. Kabat explains, is to gain "voluntary control of muscles through a part of the brain which hasn't been injured." This is a difficult, slow process, because "it is trying to make the uninjured part of the brain learn to do something it wasn't planned to do." Prostigmine makes it easier by: 1) increasing the amount of acetylcholine, a body chemical which stimulates nervous and mental activity; 2) relaxing and strengthening the muscles.

At the Kabat clinic a patient is given four doses of the drug daily and an hour of specialized muscular re-education much like that for polio cases. Treatment takes from six months to a year, and costs $200 to $250 a month. Improvement is apparently retained. Possibilities vary with the extent of brain damage, but most of Dr. Kabat's patients have improved--the speechless have begun to talk, the trembling have learned to eat with a steady hand, walk with a sure step.

Some doctors endorse Dr. Kabat's treatment; others admit he "has the germ of a good idea," but cautiously withhold full approval. Says Dr. Kabat: "I feel the results speak for themselves."

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