Prognosis of intensive reëducation in reflex (physiopathic) disorder—complete recovery (except for the hysterical fraction of the disease) not expected.
Case 566. (Vincent, 1916.)
A young soldier was superficially wounded in the left knee, in August, 1914. A year later, he showed amyotrophy of the left calf, which measured 2.5 cm. less than the right, a weak slow Achilles reflex on the left side, cyanosis and hypothermia of the left foot, weakness and limitation of movements in the left foot, with slight contracture in flexion of leg upon thigh.
Thenceforward and for eight months, this soldier was submitted at the Tours Centre to intensive reëducation. For two hours every day upon prescription he walked, ran, and hopped upon the left leg. In September, 1916, after twelve month’s training, there was a certain improvement in his disorder. The leg was now completely extended upon the thigh, and the amplitude in the movement of the foot was almost normal; but the amyotrophy, vasomotor disorder and certain electrical disturbances remained quite unchanged. The man himself recognized that his status was greatly improved, but he could not walk more than four or five kilometers without great fatigue.
In view of the inferior results of reëducation in some of these cases, should any attempt at all be made to reëducate? Vincent thinks that that should be; but that it should be borne in mind that sometimes no results may be obtained. If the reflex disorder (in the Babinski sense) is minimal and the chief difficulty is hysterical, then sometimes the man may go back to service after reëducation; but in intense examples of reflex (physiopathic) disorder, invaliding has often proved necessary.
Re values of intensive reëducation, Vincent’s technique and results have logical resemblances to those of Yealland and of Kaufmann. Vincent established in the 9th district neurological center a method of intensive reëducation which is particularly suited to old hysterical cases. He divides the treatment into three stages: First, the stage called by the poilu by the picturesque name of torpillage; secondly, the stage of fixation; thirdly, the stage of training. According to Roussy and Lhermitte, there are few cases at the front suitable for the treatment of Clovis Vincent, which is especially devised for the old cases. See under Case 574 for further details of Vincent’s treatment.
Re prognosis of the physiopathic disorder, there has been some controversy in France. See discussion under Case 530. Re suitable treatment for physiopathic disorders, Babinski and Froment suggested the application of heat. The warm bath test is also of value in diagnosis. Babinski and Froment claim progressive improvements with hot baths, hot air douches, and light baths—but counsel great prudence. The improvement is never rapid.