The lessons may be given by the physician at first and be executed
under his eye. After a few days any tolerably intelligent patient should
be able to carry them out alone, but still each new movement should be
personally inspected to make sure that it is done correctly.
In patients in the first stage of ataxia the most striking result of
incooerdination is the impairment of station. We therefore begin with
balancing lessons. The patient is directed to stand at "Attention," head
up and chest out, not looking at his feet, as the ataxic always wishes
to do. At first this is enough to require; it will not do to be too
particular about how his feet are placed, so long as he does not
straddle. He can repeat this effort for himself a dozen times a day, for
a minute or two each time. Next we try the same position with a little
more care about getting the feet pretty near together and parallel, or
with the toes turned out only a very little. In another couple of days a
little more severity may be exercised about maintaining the correct
attitude,--heels touching, hands hanging down, and eyes looking straight
forward,--and until he is able to do this _easily_ it is best to ask
nothing more.
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