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+--------------------『Dr.Karel and Mrs.Berta Bobath 』에서 
                                       The problems of crying
                                                        
        Some mothers are disturbed when their children cry during treatment. It
        should be explained to them why they cry. There are many reasons, as well:
       1. If they are in pain. This should no happen. Of things are done slowly
       and little or no resistance is felt, there is no pain.
       2. Fear. The child should not be afraid and is not so if one talks to h
       im reassuringly all the time, distracts his attention, smiles at him and
       , most important, does things slowly, and gradually, starting with easy
       and comfortable positions, and much support.
       3. Insecurity. This is a problem with every young child who cannot yet
       do things for himself, i.e., get out of difficult situations by himself,
        or protect himself, etc. It is more so in the handicapped child, especi
       ally if he has been over-protected and not moved. Everything new and dif
       ferent will make the child at first feel insecure (even the normal child
       likes to sick to his routine). But the handicapped child has to learn t
       o adjust himself to new things, otherwise he cannot progress and learn n
       ew activities. For the reason some crying cannot be avoided, especially
       at the beginning of treatment. one has to go step by step. The better th
       e child learns to cope with new situations and activities, the more secu
       re will he feel.
       4. Discomfort. Some of the things we do with the child are at first unc
       omfortable, i.e., if there is resistance to what we are doing. If resist
       ance disappears within a short time (a minute or so) continue, because t
       he child is then no longer uncomfortable. Use slight movements while in
       an uncomfortable position, best sideways, and talk to the child. Distrac
       t his attention so that he forgets. Of the child is getting used to it,
       do not change too quickly from what you are doing to something else, bec
       ause each time he will need time to get used to it again and be uncomfor
       table to begin with.
       5. Not being used to being moved. A child who has always remained well
       supported in one position does not like to be moved, for two reasons. Fi
       rst, because of his feeling of insecurity, he does not like any change,
       and movement is constant change of posture. Secondly, he is afraid of be
       ing pulled about too quickly, having his spastic (stiff) muscles painful
       ly stretched and he feels he is not able to follow with his own movement
       s those that are being done to him. This means that he cannot protect hi
       mself from falling, from being uncomfortable, from adjusting his posture
        to changes of position. If handled well, i.e., not too fast, given time
        to learn to move actively with the therapist's or mother's movements, s
       upported at the right places but not too much, he will learn to enjoy be
       ing moved. He should be moved.
       6. Protest. Even normal children of about 2 to 3 years of age do not li
       ke to be interfered with or moved in any way they do not like. They can
       protest in two ways: one, by getting out of the movements being done to
       them, e.g., turning their head away from being fed and not wanting to ea
       t, spitting food out, pushing mother's hand away, or later on running aw
       ay, wriggling out of mother's hands, etc. Two, they can speak and say th
       ey do not want certain things to be done. The young C.P. child cannot do
       any of these things and his only way of protest is crying. (Even the no
       rmal child will cry if he does not get away with other forms of protest,
        but one has to get on with the job, trying to talk to him, distracting
       his attention, etc.)
       7. Mother's attitude during treatment and at home. This is very importa
       nt. The mother might be very anxious when the child cries during treatme
       nt and/or at home when she handles him. During treatment she may think i
       t disturbs and irritates the therapist and, without even realizing it he
       rself, she may be afraid that the therapist will discontinue treatment b
       ecause the child "does not behave". It has to be made clear from the sta
       rt that she need not worry about this. Another reason may be that she he
       rself sury for himself anyway, and much more so if he has the sympathy o
       f his mother. He will regard her as an "ally" against the therapist and
       particularly the treatment. He will then also resent being treated and h
       andled by her at home in the way we are teaching the mother. This will p
       revent him from getting used to the treatment, and if he finds that it i
       s stopped when he cries for awhile, he will continue to cry for a long t
       ime in order to achieve this result. Very often the more intelligent chi
       ldren continue to protest and cry for these reasons.
                          
        Mother and therapist must cooperate, and be kind but firm and not allow
        the child to determine whether or not treatment should be done. We have
        to explain to determine whether or not treatment should be done. We hav
       e to explain to the mother that we must not waste time as anything new o
       r different will take a long time for the child to acquire, much longer
       than for the normal the normal child. Also, that we have to counteract d
       eformities from developing because, if we do not do this while the child
        is stil
        Mother and therapist must be very quiet, show no anxiety in their face
       or voice, smile at the child and be reassuring all the time, but never l
       augh at the child crying. The child must know that mother and therapist
       are not divided; that they are not angry with him for crying, but also t
       hat they do not mind him crying if there is no physical reason for it.
       THE WESTERN CEREBRAL PALSY CENTRE
                    20 Wellington Road
                    London, N.W. 8