The First Deep Breath

The ten-year-old boy who shuffled into Los Angeles' Orthopaedic Hospital one morning last week, clutching his mother's hand, had a bad case of jitters. The unfamiliar setting made Jimmy shake all over. So did his mother's gentle "Come along" when the nurse summoned them. So did his attempts to talk. He was a victim of the athetoid type of cerebral palsy, marked by almost continual jerky movements that are worsened whenever the victim tries to execute the simplest task. (In the spastic type, equally common, any effort results in slow, jerky movements.)

Dr. Robert Harrington gently strapped Jimmy into the harness of a gadget called the pneumograph. When he switched it on, Jimmy's breathing pattern showed up as two wildly irregular lines on the moving chart. Then Dr. Harrington fitted Jimmy into a chest respirator (which he is experimenting with as a substitute for the iron lung) and a positive-pressure breathing apparatus, both of which, working together, made Jimmy's breathing deeper and more regular.

Road to Withdrawal. At first glance there would seem to be little connection between cerebral palsy, which results from damage to the movement-control centers of the brain, and deep breathing. However, Speech Therapist Harrington (no M.D. but a Ph.D. from the State University of Iowa) noted the distress that besets so many C.P. victims when they try to talk. It comes, he reasoned, from the fact that breathing control is one of the motor centers most often and severely affected. This has an especially bad effect on speech. "After all," asks Harrington, "how much can you say on half a breath?" Bad speech makes patients nervous and selfconscious, so they avoid social contacts, slip into a vicious circle of embarrassment and withdrawal.

Jimmy spent an hour in the respirator. As soon as he got out his breathing fell off, inevitably, but not all the way to its original and inefficient nonrhythmic pattern. He was due for two more lessons this week. After three to six months, deeper and more regular breathing will be as natural to Jimmy as if he had been born to it. Then Jimmy will be able to speak better, to carry out more physical actions, and thus do more for himself instead of being constantly dependent on his mother. Other patients trained by Dr. Harrington have shown improvement also in mental alertness and eating habits; this may be partly an incidental effect of reduced nervousness, partly an independent effect from improved metabolism.

Converted Stable. So far, Dr. Harrington has treated 15 children and is confident that better breathing has bettered them all around. But the numbers of U.S. cerebral palsy victims are estimated as high as 750,000; at least 550,000 afflicted from birth, the rest stricken in later life as a result of wounds or infections affecting the brain. For the 15,000 in Los Angeles there are more and better-planned facilities than in most communities, largely coordinated from the office of the United Cerebral Palsy Association's center. Orthopaedic Hospital's C.P. unit is set up in a converted stable. In more conventional settings are units at White Memorial and Childrens Hospitals.

These forces maintain three main lines of attack on the problem: 1) to provide day care for patients, no matter what their plight, so that a mother will not be enslaved by the C.P. victim and can give due attention to other members of the family; 2) psychological counseling; and 3) training of every kind to help the patients become more self-sufficient. This last begins in a pre-school nursery class at the University of California at Los Angeles before the patient is three years old. (Dr. Harrington is ready to start respirator training for such toddlers.) It extends to vocational units, where adults manufacture small aircraft parts or package fountain pens under commercial contract.

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