personal view I

Teaching About Learning Difficulties PATRICIA AUTY wicw Superintendent Phy\iotherapist for the Service for People with Learning Difficulties Lewitham and Nonh Southwark Health Authority

PEOPLE wi th learning difficulties have unti l recently lived communal lives within large institutions which were situated in the country, away from populated areas. They were unseen and unknown by the majority of physiotherapists working in the Health Service. A few rare physiotherapists were working to improve these clients' welfare and well-being but their commitment and achievements were not publicised or seen by the majority. In fact, it was one of our least known and valued specialties.

Because of this unfortunate segregation of these ,clients from the rest of the population it was not felt that this specialty needed to be part of the student training nor part of the in-service training for qualified therapists. Those in the field have had t o learn by triai and error.

This situation is no longer tenable. It has been realised that people w i th learning difficulties can no longer be deprived of their right to live as part of society. With the more enlightened philosophy of normalisation, people are no longer being committed t o institutions and those living there are being moved back into houses within the community.

It follows from this that we wil l be seeing more people wi th a learning difficulty within our society and that some will need physio- therapy, whether from a specialist or a generic service.

What provisions have we made to equip physiotherapists and students w i th the knowledge, understanding and skills to work with this group of people? Maybe we should start wi th an understanding of some of the attitudes that prevail within our society towards people w i th learning difficulties - there is fear, ignorance, a devaluing of their personalities and a belief, in some cases, that they cannot learn and therefore cannot be taught. This is B daunting prospect for any physiotherapist faced w i th such a client at home or in a physiotherapy department.

It is true that some physiotherapists w i th a rehabilitation orientation have an aptitude towards certain areas of our work and in those fields they will blossom. However, we all need to know about other areas even if we do not wish to work in them. An attitude change towards this client group would be a giant step forward in the acceptance of these people as having statushights in our society. It is shameful that we have to have a policy of normalisation to understand that these clients have needs, rights and expectations like the rest of us. We should and must know that they also have a right to treatment, respect and an understanding

of their needs w h e n they enter a physiotherapy department.

Those of us working in this specialty also have a responsibility t o promote this specialist area within our own profession, to t ry t o change attitudes and to advocate on behalf of our clients. We should work to give other physiotherapists an understanding of this field and the interest, challenge and stretching of knowledge, understanding, communication and skills that this area provides. Like all other specialist areas it provides opportunities for learning, excite- ment, teaching, achievement, improvement of skills, fulfilment, stress, satisfaction and enthusiasm.

You may not have considered any of those to exist in relation to learning difficulties, but they do. When a client completes the aims and objectives that have been set jointly w i th the physiotherapist the sense of fulfilment, satisfaction and pleasure felt by both parties is just as real as with success in any other clinical specialty.

Our specialty, unlike many others, does not necessarily have an immediate or short-

term achievement; we may take six months, a year or two years to improve a function and achieve independence, but when we have finally achieved that aim it is just as rewarding.

Teaching is one of the main skills required in this field. Someone once said: 'It is not that our clients cannot learn, but that we cannot teach', a heavy responsibility! To be able t o teach how t o follow a functional programme to someone who is unmotivated (without body awareness) and who cannot use words to communicate takes consi- derable skill in task analysis. Only when the function or exercise has been broken down into its understandable parts can the client begin to work towards its eventual aim. Each achievement, no matter how small it appears to those who have no understanding of people w i th learning difficulties, has been hard-won by determination, effort and patience, and the satisfaction it gives t o both the client and the physiotherapist inspires both to continuous effort.

Being an enthusiast in this specialist area I find it difficult t o understand why more physiotherapists do not venture into it. The only reason must surely be that they have not had the opportunity to learn about this valuable client group.

Visit to the Republic of South Africa

MARGARET JOHN MCSP

IN the autumn of 1988 I was very proud to receive an invitation to give a keynote lecture at the South African Society of Physio- therapy 18th Congress, to be held in Durban in May 1989.

When I accepted the invitation to speak on the McKenzie approach to the diagnosis and treatment of low back pain, and lead an afternoon workshop, I asked if any other regions would like me to conduct a McKenzie course, while in South Africa. I was thrilled when four groups invited me to do so.

M y plans went ahead and I prepared for t h e t r i p of a l i fe- t ime, land ing in Johannesburg at the beginning of May where I joined a tour party travelling through the Kruger National Park - it was so exciting. We saw lions, leopards, elephants, zebras, giraffes, etc, etc, then we visited Swaziland and Kwazulu - the home of the Zulu tribe, and finally travelled into Natal and down to Durban.

This beautiful city welcomed physiother- apists from all over South Africa and i t was a joyous four days, truly living up to the congress theme of 'Widening Horizons'.

The congress was attended by almost 400 delegates - a good proportion of the membership, as there are only 5,000 physiotherapists in the whole of South Africa.

It was a very enjoyable and successful

congress, followed by a stimulating Council and annual general meeting, at which many far-reaching policies were discussed and agreed.

M y travels then took me for my first post- congress course to Bloemfontein in the Orange Free State, near the site of many Boer War battles. Then on to Cape Town, where w i th Stephanie Saunders who was also a speaker at the Durban congress, and who w i th Liz Edwards and Mrs Duffy Sweatman presented Cyriax courses pre- and post-congress in Johannesburg and Cape Town, I had a brief respite, and then on the only wet day of the trip, together we toiled up to Cape Point and viewed the meeting of the Atlantic and Indian oceans!

Another lecture course followed and then some more sightseeing, before flying to Pretoria, and then on to Johannesburg, for the fourth and last course.

All the groups were Maitland or Cyriax trained manipulative therapists, yet all were so pleased to acquire another approach to the examination and assessment of their patients, plus the treatment skill of helping the patient t o become self-reliant and independent of therapists in the manage- ment of future low back pain.

The friendship, enthusiasm and hospitality attached to each course was heart-warming and even nicer were the final messages saying 'please come back again soon', which carried me on to the last stop of my tour - a visit to Zimbabwe, and the fantastic Victoria Falls.

Physiotherapy, August 1989, vol 75, no 8 462