Cerebral palsy diplegia: improvements for walking.

Ever since Little described cerebral palsy in 1862' treatment has been given-by both rational and irrational methods-in the hope that physical improvement will occur and the child will be able to walk. In those with diplegia, though progress is slow and often tedious, the posture usually improves, balance matures, and walking may be possible by the age of 2 or 3. Beyond this age different treatment methods are used, sometimes uncritically, by different professionals. Such is the diversity of the condition of cerebral palsy and the treatment regimens used that acrimonious argument often occurs among centres offering treatment. This may cloud the issue of effectiveness of treatnment. One of the most potent changes is the maturation that occurs with age and growth. Beals showed that the motor performance of spastic diplegic children changed up to the age of 7 and that improvements seen are not necessarily related to treatment.2 Last week the Health Minister, Mr David Mellor, told parliament that local authorities will be able in future to send children abroad for treatments not available in Britain. He gave the Peto Institute in Hungary as an example. Whether "conductive education" as given at the Peto Institute is better than other treatments has yet to be proved. On p 1145 Drs Robinson, McCarthy, and Little, all paediatricians, recount their experience of a visit to Hungary. The conclusions about the use of such a novel education method are of great importance to the future influence of this system on British care. Instead of being the media led "hype" and relaying the fascination that the Peto method seems to engender in the public in Britain the report simply states what was observed. Clearly, patients with cerebral palsy are carefully selected at the Peto Institute, and those treated usually benefited from the intensive and coordinated work. The authors speculate on whether a "been to Hungary" label is worth while and conclude that treatment regimens in Britain are at best as good as those in the Peto Institute. It is unnecessary for all the children with cerebral palsy in Britain to rush abroad. Dr Robinson and colleagues compliment conductive education as a model for the multidisciplinary system of care we believe in and try to practise. They were also impressed by the use of all activities to improve function-not merely a short physiotherapy session in the school for the physically handicapped. It is thus all …