Surgical intervention and orthotic appliances

Abstract

The relationship between physical handicap and mental retardation is a very complex one. A very high proportion of those who are severely mentally retarded also suffer from physical defects associated with various types of cerebral palsy. While it is generally true that many children and adults with severe mental retardation also have severe physical defects, there are a considerable number of exceptions. Moderate, or even severe mental retardation may not be associated with any muscle weakness or abnormal muscle activity such as constitutes cerebral palsy. Children may have shown delay in the time at which they start to achieve certain activities such as sitting, standing or walking but, given time, they eventually do so. Conversely, some children, severely affected physically, particularly in certain types of cerebral palsy known as ‘athetoid cerebral palsy’, may have such difficulty in performing purposeful movements that they cannot achieve any of the motor skills that would be normal for their age, either in the use of their lower limbs for walking or the upper limbs for carrying, holding, writing, or similar activities. They may nevertheless have quite a normal intellect, which is often submerged behind the physical disability. This is particularly so when it is associated with severe speech handicaps. These are the sort of individuals who, once they have been given sufficient help with their limited physical capacity to be able to communicate through the aid of modern computerized devices, become able to express themselves, to write books and to show the adequacy of their intellectual capacity. Nevertheless, the majority of people with profound retardation will not show such a dramatic response to intervention. Nothing that the surgeon can do can hasten development of motor ability in people with mental retardation and surgical treatment can rarely give other than slight benefit by the application of suitable splintage to suppress unwanted movements in those who suffer from athetoid types of cerebral palsy. It is with the more common combined physical and mental handicaps that orthopaedic surgery has something to offer. For those professional people, such as physiotherapists, who may wish to have further details, the textbooks by Bleck (1987) and Sharrard (1979) are recommended.