OFFICE OF VOCATIONAL REHABILITATION Number of persons with cerebral palsy rehabilitated, fiscal years 1945–53 Number of persons with cerebral palsy rehabilitated, by State, fiscal years ended DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Mr. HARRY LYONS, Legislative Director, United Cerebral Palsy. New York, N. Y. DEAR MR. LYONS: This will acknowledge your letter of November 30, 1953, requesting information about the accomplishments of the Federal-State vocational rehabilitation program during 1951 and 1952. The total number of disabled persons served under the program decreased from 231,544 during 1951 to 228,481 in 1952. The number of persons reported as rehabilitated decreased from 66.193 in 1951 to 63.632 in 1952. The proportion of cerebral palsied among the rehabilitated group remained constant during this 2-year period -1.3 percent. The Federal appropriation for the program was $20.6 million in 1951 and $21.5 million in 1952, or an increase of $990,000. There are several reasons for the slight decrease in the number of persons rehabilitated The inflationary costs of "cost-of-living," salary adjustments for State agency personnel, and services purchased for disabled persons-such as hospitalization more than offset the $900,000 increase in Federal appropriation. The cost of maintaining the national program per person rehabilitated was $514 in 1952 in contrast to $457 in 1951. Then, too, the State rehabilitation agencies have been shifting program emphasis toward serving larger numbers of the severely disabled. As you know, rehabilitation of the severely disabled is more costly and difficult. At the request of your Washington representative, we are sending you copies of our recent publications, under separate cover. If there is any further information you desire, please do not hesitate to call upon us. Sincerely yours, D. H. DARFI STEIN, Assistant Director. Dr. BROOKS. Thank you, Mr. Chairman and members of the committee. Mr. Chairman and members of the committee. I am Dr. Glidden L. Brooks of New York City, N. Y., medical director of United Cerebral Palsy Associations, Inc. We appreciate this opportunity to present testimony on behalf of the cerebral palsied. United Cerebral Palsy Associations is a nonprofit membership corporation founded in 1948-the only nationwide organization devoted exclusively to a united attack on cerebral palsy. Its humanitarian work is supported by voluntary contributions. The members, officers, and board of directors serve without compensation of any kind. Its national headquarters are at 369 Lexington Avenue, New York City. United Cerebral Palsy comprises 200 affiliates, State and local organizationus throughout the United States dedicated to making it possible for the cerebral palsied to take their proper places as participating members of the community. The term "cerebral palsy" denotes a complex and highly variable disturbance of function which is the outward reflection of damage to the brain. The most prominent reflection is disturbance of motion. although other functions mediated in the brain may also be affected, depending upon the location of the damage, the number of cells destroved, and other complext factors. The brain is a highly complex organ and anything that happens in it is apt not to have simple readily definable results. Such damage can be caused by any type of injury, or by failure of the brain to develop before birth. Most adults have learned as children to eat, walk, talk, and perform countless functions of everyday living quite naturally and almost LIBRARIES automatically. This is possible because normal people with undamaged brains establish delicately balanced control of their muscles so that they work together smoothly and efficiently. A person with cerebral palsy has suffered damage to the mechanisms which provide this delicate control. The appearance of a person so afflicted has often led the uninformed observer to the conclusion that the cerebral palsied individual is feebleminded. His muscles are out of control. He may drool and his facial appearance may show contortions, and the like. This affords an unthinkable injustice to the large numbers of cerebral palsied individuals who are intellectually normal or superior. It is true, however, that others suffering from cerebral palsy have also sustained the additional handicap of impaired intellectual ability. One of the most difficult parts of the cerebral palsy problem is that of helping adults to become self-sufficient members of industry and society. Estimates indicate that there are some 550,000 persons in the United States who are suffering from cerebral palsy. With unrelenting regularity about 10,000 babies are born with cerebral palsy annually, 1 every 53 minutes. The caseload of cerebral palsied persons is growing steadily as attention is directed to the problem. According to the most authoritative evidence available there are approximately 350,000 adults with cerebral palsy in the United States. A spot check leads us to believe that about 50,000 cerebral-palsied adults are engaged in some sort of remunerative occupation. A certain number of these people must grow up and we must face the situation. People do not die of cerebral palsy. They die of something else, but they have cerebral palsy all their lives. The responsibility for the employment rehabilitation of the cerebral palsied was assumed by the Federal Government, but the Federal Government found itself incapable of meeting the need. In 1953 with the corporate income of the United States at the highest level in history and the total income of the Nation at a correspondingly high level, we were able to provide opportunities for only one-fourth of 1 percent of the adult cerebral palsied. These people needed work, wanted work, and many could be adjusted, or to a decent life, or even a tolerable life in their communities, by having a job. The most prosperous Nation in the world at full industrial and economic capacity could provide employment for only 800 adult cerebral palsied through its governmental machinery. This record of providing employment rehabilitation to victims of cerebral palsy should give us pause. It demands that vigorous, constructive action be taken to prevent its recurrence. We are, therefore, asking the Congress through this committee to step into the breach and do something constructive for these truly forgotten men and women. There are about 350,000 in the country, and only about 50,000 of them have jobs, which, because their handicap is mild, they have been placed in by other agencies and the like, which leaves a backlog of 300,000, not all of whom are employable, but certainly more than 800. As a physician, my primary medical background has been in pediatrics, which deals with the care of children. This is necessarily a forward-looking branch of medicine, since what we are, in effect, doing is helping to prepare children to be as effective adults as their health and their nation will permit. We are preparing the child for his potentialities and what the potentialities of the community in which he lives can offer hin.. When a child is sick and we as pediatricis take care of him, we are looking upon him quite often as a potential adult. In a chronically ill child with cerebral palsy who is chronically ill, he has a permanent long-term disability, and the final phase, of course, or very nearly the final phase, is vocational rehabilitation so that he is able to get a job. One of the reasons why I am here today is it is very disturbing to me personally to see this field of vocational rehabilitation, espe cially today in cerebral palsy, receiving so little attention that it is by way of becoming a bottleneck. It makes it rather pointless to spend hours of skill and time and considerable heartache on a child, seeing him through this and through that, and growing up with him and pointing him ultimately toward getting a job, and then finding a bottleneck just before the final goal should be obtained. While the physical disability of other handicapped persons interferes with their prospects, guidance, and training, the situation for the cerebral palsied is intensified because the multiple complexity of their involvement produces multiple disabilities in the same individual. He does not have just one thing wrong with him, but he has a number. The present limitations in the act in effect exclude the cerebral palsied from the benefits which Congress clearly intended for all the handicapped. It has been said, "Employment is nature's best physician-it is essential to human happiness." To a person like the cerebral palsied, who has never known success, but has been categorized as atypical and looked upon by his family, his friends, and the community as grossly unfit, and perhaps, unjustly, as feebleminded a job assumes even greater importance than to the physically able or people with lesser handicaps. We know how destructive it is to a person to find he is rejected or pitied by his family and his peers and finally to find his hopes and ambitions shattered when he discovers the sign "No help wanted" displayed for him without benefit of a fair trial. From the standpoint of national economy, it is far less costly to habilitate an individual and prepare him for even partial employment than it is to keep him as a public charge for a lifetime. Some cerebral-palsied individuals have through their performances adequately demonstrated their ability to become self-supporting, contributing members of society. We are convinced that many more could, with additional preparation and opportunity, take their places in industry and enjoy not only the benefit of economic status, but also the attainment of social acceptance and the very important personal satisfaction which comes from a sense of belonging-of contributing. For his happiness and self-respect every individual must have significant work to do, fitted to his individual capacity. The latest published statistics from the Department of Health, Education, and Welfare indicate that $92 cerebral palsied were rehabilitated in 1919; 819 in 1950; 881 in 1951; and 809 in 1952. LIBRARIES The Office of Vocational Rehabilitation of the Department of Health, Education, and Welfare has graciously cooperated by compiling for us two sets of figures which will vividly illustrate the plight of the cerebral palsied in his quest for aid. These figures, copies of which have been submitted attached to this testimony, show first the number of cerebral palsied rehabilitated from 1945 to 1953, and second, the number of persons with cerebral palsy who have been rehabilitated and placed in jobs by individual States. You will note there is a figure of 800, or in some years somewhat more than 800, but never more than 900, which we mentioned earlier in the testimony. The jobs filled range from unskilled to highly technical and professional. These statistics indicate that when the cerebral palsied has the opportunity for training and proper guidance through proper job placement there is no doubt that he can make his contribution to society-not only in the service, but incidentally as a taxpayer rather than a public ward. Industrialist Louis C. Whiton, president of the Prat-Daniel Corp. of South Norwalk, Conn., who, as the first voluntary chairman of United Cerebral Palsy's vocational guidance program, has pioneered in this field, maintains that we are not properly utilizing these hidden human resources of our society. He points out that among America's cerebral-palsied adults there exists an undeveloped potential asset to the industrial, business and cultural life of the Nation. According to a letter received from Mr. D. H. Dabelstein, Assistant Director of the Office of Vocational Rehabilitation, dated December 16, 1953, a copy of which has been submitted to your committee *** the State rehabilitation agencies have also been shifting program emphasis toward serving larger numbers of the severely disabled. He continues by saying: As you know, rehabilitation of the severely disabled is very costly and difficult. A pamphlet issued by California State department of education, bureau of vocation rehabilitation, says: Many physical or mental handicaps can be removed through vocational rehabilitation services. Many others can be reduced to the point where they do not interfere with the work demands of a properly selected job. When the disability has been properly treated and the person properly trained for and placed in the right job, he can do that job as well as anybody. It's not what a man has lost, but what he has left that's important. We are concerned with a serious disability which is much more difficult and expensive to approach with rehabilitation techniques than is the case with many other handicaps. It is obvious to us that a program inadequately financed will never reach down deeply enough into the reservoir of the handicaps to do much about cerebral palsy, but rather will be expended on the easier and more rewarding problems. Therefore, as we view it, the amount suggested by the President for Vocational rehabilitation of $28 million is not enough. It certainly should be closer to $50 million, and perhaps $75 million. According to an article by Dr. Howard A. Rusk that appeared in the New York Times on Sunday, January 10, 1953, the Nation paid more than $430 million in 1952 for the disabled persons on public assistance rolls. In the same article Miss Mary E. Switzer, Director of the Office of Vocational Rehabilitation, noted that: |