Miracles on 34th Street

Any multimillionaire can surely afford to seek out the world's best medical care. If he happens also to be the father of the President of the U.S., his search can command unlimited assistance. But picking a hospital for Joseph P. Kennedy, victim of a severely paralyzing stroke five months ago, was no problem at all. Last week the former ambassador was flown to the world's largest hospital of its kind: Manhattan's pioneering Institute of Physical Medicine and Rehabilitation, overlooking the East River at 34th Street. That Kennedy could face a long program of intensive treatment was evidence of how much he had improved.

The 73-year-old patient was indeed a special guest. He was put up in Horizon House, a five-room, ranch-style home built on the institute grounds as a demonstration model of a stepless, stairless dwelling tailored to the needs of wheelchair patients. There, visits from his anxious family would be more convenient than if he were in one of the usual four-bed wards. But Kennedy's medical problems are the same as those confronting a million or more non-millionaire Americans who are the victims of similar strokes, and the measures to be taken to treat those problems will be the same.

Dominant. President Eisenhower and Sir Winston Churchill had relatively mild strokes from which they recovered fully and quickly. Ike had no limitation of movement, and the slurring of his speech lasted only a few days. Joe Kennedy's case is far more typical. A clot clogged an artery and cut off the blood supply to a major part of the left side of his brain.

Since he is righthanded, this left hemisphere of his brain was dominant; in it are the nerve controls for muscles on the right side of his body. Perhaps even more important, the left hemisphere contains the language center through which he receives and interprets the written or spoken word, and formulates ideas to be expressed in words.

The hemiplegia ("half paralysis") in such cases tends to fall into a set pattern, and treatment is similarly standardized.

The arm on the affected side is usually more severely paralyzed than the leg. If a patient can lift his arm at all. or if he can raise his leg an inch from the bed, chances are good that he will be able to walk again.

Inactivity is the patients' worst enemy; their muscles atrophy and tendons shrink.

At the institute, the basic therapy is to see that patients have little idle time.

Compulsive. Most hemiplegics are compulsive personalities, which may be why they get strokes. "Our patients are used to moving fast and getting things done." explains Jack Hofkosh, 40, chief of physical therapy. "They like the busy pace here at the institute. Though rehabilitation is necessarily slow and monotonous, the patients put in a grueling day, with their every activity directed toward resuming a normal life."

The institute's specialists take a week to evaluate each patient in terms of physical potential, language disability, and medical and psychiatric problems before any treatment starts. Then the first physical therapy is begun: a therapist asks the patient to lift his arm as if to put a spoon to his mouth. Most likely he cannot complete the movement, so the therapist (usually a woman) gently helps him. At times she gets him to push his hand against hers to strengthen the muscles. Hemiplegic patients stay at the institute an average of three to six months. "By the time they leave." says Hofkosh. "we like them to be able to walk at home and take care of their basic needs."

Receptive & Expressive. Beyond a stroke victim's physical difficulties there is another more variable, less understood, and--until recently--more neglected problem: language disability. The technical name, aphasia, covers far more than its literal meaning, "loss of speech." Usually, neither innate intelligence nor accumulated knowledge is destroyed, but access to each is cut off from the patient by a breakdown in his communications system. This breakdown may damage the receptive (reading and listening) functions, or the expressive (speaking, gesturing, writing), or both, in infinitely various combinations.

Explains Martha Taylor, 34. the institute's chief of speech and hearing therapy: "Although there are more than 6.000 speech correctionists licensed to practice, few of them have had any training with stroke victims. Most got their training with children, who have language problems of a totally different kind. We had to devise our own tests to rate our patients, because we get the severe cases or those who have had no success elsewhere. Most important, our patients are nearly all the kind who cannot get along without language skills--business executives and professional men."

After a stroke, these verbal types become intensely frustrated when they cannot use language effectively. The frustration may be so intense that it provokes emotional disturbance leading to physical violence. "But a certain amount of frustration is a good sign for chances of recovery," says Mrs. Taylor. "It's normal to be frustrated when you can't talk." From the first evaluation tests of patients by her staff of eight therapists. Mrs. Taylor nearly always finds that family members have a deep and extremely dangerous misunderstanding of the problem.

"Because the patient looks attentive and friendly, and perhaps tries to nod, they say. 'Oh, he understands everything, but he just won't talk--he's stubborn.' Then they tell us how he reads the newspapers.

They don't realize that he may look at the stock tables in the paper from habit, without understanding them. They don't realize how deeply this language difficulty cuts into the receptive as well as the expressive faculties."*

Repetitive. Using Taylor-made materials, institute therapists begin with pictures of 100 everyday objects and 100 cards bearing the objects' names in large type. ("Nouns are the first words we learn and the easiest to relearn," Mrs. Taylor explains.) Lessons begin at the first-grade level: two pictures, two name cards. The patient tries to match them. When he can match 75 out of 100, he proceeds to the next step: picking up the right picture when the therapist names the subject. In most cases, the patient is next helped to write the names of such familiar objects as "shoe" or "lamp." Only after such lessons does the therapist expect the patient to be able to repeat the names of the various objects after her.

To master such simple skills, it takes many patients endless hours of practice--more than a human therapist could endure giving. The patient is taught to use a machine into which he feeds IBM-type cards bearing a picture, the printed name of the object, and a piece of recording tape on which its name is repeated. The ten hours a week of speech retraining also include some group sessions, where patients share their problems and their triumphs as they graduate from nouns to verbs, and finally to prepositions--the littlest and most difficult words of all.

"Dr. Rehab." The Institute of Physical Medicine and Rehabilitation is a monument to a smoothly persistent Missouri-born physician who practiced internal medicine in St. Louis before World War II. Later, as a Medical Corps officer in the Army Air Forces, Dr. Howard A. Rusk found himself caring for wounded men who had no hope of regaining normal activity. And the medics had no hope for them, either. Dr. Rusk recognized a crusade and a new life work.

Before war's end, he got rehabilitation programs rolling for airmen. Backed by Elder Statesman-Philanthropist Bernard Baruch. he made a study of what would be needed to set up the world's first medical center devoted exclusively to rehabilitation. Out of uniform. Dr. Rusk began a pilot program at New York City's Bellevue Hospital. After a short spell in temporary Manhattan headquarters, in 1951 he opened the present institute, a unit of the New York University Medical Center. It is still growing, and the U.S. Public Health Service has just begun to give it $500,000 a year for rehabilitation research and training alone.

Today, Rusk is the nation's "Dr. Rehab." When the President's father was stricken, it was almost inevitable that the institute builder would be called in--and that the stricken financier would go to Dr. Rusk's hospital for treatment.

*In an effort to alleviate such home-based difficulties, Martha Taylor has written Understanding Aphasia. Published by the institute for 50-c-, it has sold a phenomenal and unexpected 80,000 copies in English, has already been translated into Spanish, Portuguese and Japanese.

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