The purpose of this book is to discuss the management of calf muscle hypoextensibility bringing in elements of current debate about this topic and suggestions for reordering the common sequence of intervention for this problem.
This text is organized by topics, including 19 main topics and 13 appendices. The first 8 topics cover background information: the somatosensory system and postural control; the ankle and foot in normal gait; postural control deficits in children with diplegia; elements of optimum muscle function; spasticity and hypertonus—differences and similarities; physiologic transformation due to excessive muscle recruitment, immobilization, and hyperactivity in the shortened state; the length-tension relationship—a clinical concern; and triceps surae hypoextensibility—pathomechanics and pathokinesiology.
These first 8 topics are intended to provide the reader with the elements of current debate, for example, the role of the somatosensory systems in the development of human postural control with a focus on center of mass (CoM), the identity of the foot and ankle as essential components for weight loading through the heel and their links to the CoM in gait, and the cause of postural deficits in children as the consequence of sensorimotor deficits influencing CoM and gait. An additional topic is the discussion of the concepts of spasticity and hypertonus and their relationship to postural and functional deficits of the calf muscle with resultant effects on gait. These topics are often presented as lists, bulleted referenced points, or short synopses of literature.
The next 3 topics are assessment and management—quantifying spasticity and calf muscle extensibility; measurement procedures—passive ankle dorsiflexion range of motion assessment; and hypoextensibility management options—old and new. The first 2 topics under assessment and management provide detailed directions and guidelines with pictures to aid the reader in skills and reliability in measuring dorsiflexion. The last topic has 9 subheadings that describe treatments for both adults and children. New thinking is presented about ankle-foot orthotic (AFO) designs, tuning AFO-footwear combinations, tuning principles inherent in serial casing with weight-line training, and the enhancement of the effectiveness of a weight-line training program; this information has limited references. The other hypoextensibility treatments described are chemical, that is, botulinum toxin A, and modalities for spasticity such as cryotherapy, surgery for shortened calf muscle(s), and below-knee casing. These treatments are referenced.
The subsequent 6 topics include serial casting protocols, serial casing procedures, cast check-out and posting principles, cast and body care and management, principles of treatment in cast(s), and tissue extensibility maintenance and life-long body care. The casting topic areas contain detailed information about when to and when not to cast, precautions, problems and limitations of casting, materials, designs with pros and cons of each, obtaining appropriate alignment, and step-by-step details of casting. The last offerings are follow-up procedures after the casts are applied, patient education, and targeted training strategies while in the casts.
The final 2 major topics include a general summary and references and readings. The general summary is presented in table format with 2 columns: existing thinking about equines deformity and newly informed thinking. There are 24 points in each column, but no references are cited to support these concepts. Reviewing this summary first may assist a reader somewhat with a framework for linking the topics in this book. The references and readings cover some of the topic areas, but not all.
The last section of this book comprises appendices. The first 9 appendices (noted as 1-6 plus 1A, 1B, and 1C) contain forms that can be reproduced for clinical use. For example, Appendix 1 is the Assessment Form for Equinus Deformity Management and Appendix 1A is the Grading Rubic-Passive Ankle Dorsiflexion ROM. These forms are related to the 6 topic areas of serial casting identified earlier. This is a strength of this book. The last 4 appendices (ie, Appendix 7, 7A, 8, and 9) are for reference only. An example is Appendix 7: Elaine Owen's Algorithm for “Tuning” AFO & Shoes.
The most salient features of this text are the details regarding measurement of dorsiflexion, casting, and the forms that can be copied for use by the clinician. Background information on the elements of argument for debate in treatment is limited. The reader is left to make the link from one topic to the next in the beginning of this book.
A major distraction in reading this book is its poor editing including missing words, run-on sentences, use of unrecognized abbreviations, use of abbreviations in the text without full spelling of the term or terms at first appearance, and a mixture of 2 different reference styles, that is, numbered in list and use of author and date in the text.
This book was intended for use by physical therapists, physical medicine and rehabilitation physicians, orthopedists, orthotists, physical therapist assistants, and orthopedic technicians “... who are called upon to make decisions about orthotic design and who undertake serial cast application ... for foot deformities of soft-tissue origin.”(pi) It was written under the assumption “that the reader understand the basics of foot anatomy, biomechanics, and pathomechanics.”(pi) At this time, I would only recommend this book as a possible reference text for those who use serial casing techniques for soft-tissue equines deformity.
Karen Kott, PT, PhD
The purpose of this book is to provide a useful resource for occupational and physical therapists who provide care and treatment for children with cerebral palsy. Other healthcare professionals, caregivers, families, and those individuals who have a diagnosis of cerebral palsy (CP) may also find this book valuable.
The book is organized into 4 sections. Part one covers an introduction to the clinical reasoning model used throughout the book, and a synopsis of key issues such as the definition and classification of cerebral palsy, understanding the family's perspective, and an overview of therapeutic approaches. Parts 2 through 4 are presented in case-based format and provide a framework to use and apply the model introduced in the beginning of the book. Part 2, in particular, addresses issues that are relevant to the preschool years with a focus on the family. Part 3 focuses on the children as they make their way through childhood and adolescence and begin the transition into adulthood. Part 4 addresses the concerns that adults face with a diagnosis of CP. Finally, the book offers an appendix that contains a brief description of measurement properties and tools that should be considered when choosing an instrument in the evaluation process.
Chapter 1: This chapter lays the foundation for understanding the clinical reasoning model utilized throughout this book. The chosen model is based on the International Classification of Functioning, Disability and Health1 in conjunction with the Intervention Process model adapted from the Canadian Occupational Performance Process Model.2 Strong emphasis is placed on a family-centered approach to intervention.
Chapter 2: Chapter 2 is an overview of CP; the definition, classification system describing the different types of CP, and an introduction to the Gross Motor Function Classification System Children3 for children aged 6 to 18 years. In addition to this, the Manual Ability Classification System4 is also presented. This classification system identifies the child's ability to handle objects during daily activities. Impairments associated with CP are reviewed briefly.
Chapter 3 by H. Bourke-Taylor: Family is an integral part of this book and is woven into every section. However, this chapter specifically discusses the family perspective and parenting the child with CP. Suggestions are laid out in list format highlighting the important points families would like every therapist to include in the care of their children with CP. This chapter is a helpful reminder that families should play a critical role in directing the care of their child and serve as important members of the team.
Chapter 4: The last chapter of this section is a brief overview of common therapeutic approaches for the treatment of CP. The chapter is divided into 3 categories: general therapeutic approaches, therapeutic interventions, and common medical and surgical procedures. Clinical application of these interventions and medical-surgical procedures are then used in the case-based studies presented in the remainder of the book. Although this chapter does not elaborate on the covered topics in any detail, the authors do acknowledge it as an overview and point out its brevity. Therefore, it serves as a quick reference only.
PART 2: THE PRESCHOOL YEARS
Chapters 5 and 6 by S. Foley and S. Greaves, and K. J. Dodd and S. Greaves, respectively, describe an infant with complex needs and a young toddler born prematurely. The authors proceed to take the reader through multiple stages of treatment development. Each chapter in this section is laid out in stages as follows: (1) description of the case and initial data collection; (2) identification and prioritizing concerns; (3) identifying relevant theory to guide management—within this section (a) biomechanical frame of reference and (b) theories of motor development; (4) a breakdown for assessment of body structure and function, activity, and participation; (5) discussion of issues of contextual factors—environmental and personal; (6) the management plan; and (7) the implementation of the intervention plan. In conclusion, the chapter offers stage 8 to evaluate the outcomes in each area addressed. This systematic approach is organized and structured in a way that assists the reader in considering all aspects of treatment and care of the client and family.
Chapters 7 and 8 by M. Wallen and Christine Imms and B. Hoare and Christine Imms, respectively, highlight interventions of modified constraint-induced therapy and goal-directed training of activity performance. These 2 therapy approaches have been studied in research environments and then modified for clinical use. Each chapter references the theory and research behind the therapeutic approach featured. Although they acknowledge that this is not an exhaustive list of references, many of the classic references are left out.
PART 3: THE SCHOOL YEARS
Part 3 follows individual cases transitioning through the school years.
Chapters 9 to 13 continue to lay out one case study per chapter ranging from 5 to 12 years of age. Each chapter features an intervention procedure.
Chapter 9 by P. Thomason and K. Graham highlights the role of botulinum toxin A injections in the lower extremity. Chapter 10 by A. Harvey describes physical therapy following a single-event multilevel surgery. J. Duncan, in Chapter 11, looks at occupational therapy following upper extremity surgery in a 10-year-old child with hemiplegia. Chapter 12, written by M. Mayston, takes on the issues of school-based needs and technological supports in secondary schools. Finally, Chapter 13 addresses how to incorporate strength training as in intervention for adolescents. Each chapter follows the stages of the clinical reasoning approach laid out in Part 2 of the book.
PART 4: ADULTHOOD
The fourth and final part of the book deals with transitioning to and through adulthood. Chapter 14 by M. Law and D. Stewart covers transitioning to adulthood whereas Chapter 15, written by B. Scoullar and C. Imms, provides a case study of a young adult with complex disability. The therapy needs and many challenges that are often overlooked in this age range are addressed using the case study model established earlier in the book. The family remains a critical component through all developmental stages of life.
Physiotherapy and Occupational Therapy for People With Cerebral Palsy: A Problem-Based Approach to Assessment and Management would make a great addition to a professional-clinical library. Families and caregivers may also find the book useful in terms of specific issues related to therapeutic approach or medical-surgical procedures that may relate to their child individually. However, clinicians would benefit the most from this publication. Although it may not be appropriate for students because it does not provide detailed background for topics related to therapeutic approaches, therapeutic interventions, and medical-surgical procedures, educators will find multiple uses for the content of this book. Several sections of the text could provide a foundation for building curriculum in entry-level programs for health-related professionals.
The book provides a common thread throughout with a clinical reasoning approach that is laid out initially in Chapter 1. This approach is structured, organized, and provides a great framework for clinical practice. Family is stressed as a critical component to the overall development, management, and success of the child with CP. Parts 2 through 4 offer practical application for the use of this model and although not all inclusive cover some of the most common scenarios seen in this population. Other books have presented case studies to highlight interventions; however, this current publication builds a solid foundation by developing a problem-based approach and further reiterates the importance of a multidisciplinary team with key players being family and client. Each chapter contains illustrations in the form of tables, figures, and boxes with information that additionally clarify or summarize important points. Within the text of each chapter, key points are bulleted to draw the reader's attention and allow for quick reference.
There is a European bias in the book with regard to terminology, medical-surgical procedures, and some of the therapeutic interventions offered; however, this does not detract from its usefulness as a reference. Some of the information in the book is based on statistics from the Surveillance of Cerebral Palsy in Europe 2000 and the Australian Standards of Care 2008.5,6 These references may not be representative of CP in the United States and therefore should be considered accordingly.
Claudia R. Senesac, PT, PhD, PCS