Pediatric Physical Therapy:
doi: 10.1097/PEP.0b013e31828f2ae1
Section Information: Book Reviews

Book Reviews

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Asymmetry and Infants Born Preterm, by Jacqueline Nuijsink. Utrecht, the Netherlands: Utrecht University Library, Medicine; 2012, softcover, 175 pages, ISBN: 9789039358320, 12,21 Euros.

This book contains the doctoral thesis of a pediatric physical therapist who investigated symptomatic asymmetry (SA) and idiopathic asymmetry (IA) in infants who were born preterm. The book is divided into 7 chapters, with introductory and summary chapters at the start and finish of the book, and 5 chapters that each contain an independent but logically linked journal article. Chapter 1 provides a coherent and in-depth introduction by describing first the relevance, etiology, and risk factors for asymmetry and subsequently the general characteristics of prematurity, intra-uterine growth retardation, and motor performance sequellae. These sections are followed by an introduction to the 3 instruments used in the thesis and the problem of predicting motor development, particularly for infants born preterm. Theories of motor development are briefly mentioned. Finally, the aims and outline of the substantive chapters are presented.

Chapter 2 is titled “Symptomatic Asymmetry in the First 6 Months of Life: Differential Diagnosis” and is co-authored by Nysink, can Haastert, Takken, and Helders. This comprehensive review determines and classifies the possible causes of asymmetry in young infants and also reviews the 9 most prevalent disorders in the first 6 months of life leading to the diagnosis of SA. The importance of a differential diagnosis between SA and IA is promoted leading to the topic of Chapter 3, which is “Symptomatic Asymmetry in Very Young Infants: A Delphi Study on the Development of a Screening Instrument.” Chapter 3 (written with the same co-authors) describes how experts (including pediatric physical therapists) were consulted, using a 2-round technique, to develop this needed differential diagnostic screening instrument. The instrument contains a classification scheme, clinical diagnostics criteria, and a list of red flags. Although cross validity and reliability remain to be established, in the appendix the authors provide a nice summary of the strengths and weaknesses of their qualitative approach as well as further details of the instrument and guidelines for use.

Chapter 4 focuses exclusively on IA, with the title “Prevalence and Predictors of IA in Infants Born Preterm” (co-authors, van Hasstert, Eijsermans, Koopman-Esseboom, van der Net, de Vries, & Helders). This well-conducted retrospective study reports the prevalence of positional preference at term and deformational plagiocephaly (DP) at 6 months adjusted age in 192 infants (gestational age [GA] ≤ 32 weeks). Predictor variables of DP are reported as well as motor development at 6 months measured by the Alberta Infant Motor Scale (AIMS). With 2 data points and limited assessment, the authors suggest that a more comprehensive assessment is needed in a prospective study, which is the focus of Chapter 5, “Natural Course of Asymmetric Motor Performance and DP in Very Preterm Born Infants” (written with the same co-authors as Chapter 4). A prospective cohort of 120 (GA < 30 weeks; birth weight < 1000 g) was assessed around term age, then 3 months and 6 months later. In addition to assessing asymmetry, 3 motor performance assessments were undertaken: General Movements (GMs), AIMS, and the Test of Infant Motor Performance (TIMP). This longitudinal study design provided a rich dataset, but the authors remind us that the results represent associations and not causative relationships.

Finally, in Chapter 6 “Prediction of Independent Walking in Infants Born Preterm Using the TIMP and the AIMS,” the same authors who wrote Chapters 4 and 5 add to the psychometrics of these 2 tests. Specifically, they use a large subset (113) from the study reported in Chapter 5 to determine concurrent and predictive validity relative to independent walking. Overall, the results support concurrent more than predictive validity and suggest the importance of factors such as cultural or individual variables over medical history in predicting independent walking. Chapter 7 provides a summary of the previous chapters as well as a short general discussion on how the findings relate to clinical decision making and predictions. This chapter ends with sections on clinical implications and directions for future research. The last 25 pages of the book are devoted to a summary chapter, acknowledgements, and information about the primary author written in the Dutch language.

Since this book is a doctoral thesis with the main chapters either published (3) or submitted for publication (2), one could argue that it is not worth buying since the chapters are available as journal articles. However, this would probably be erroneous thinking for any pediatric physical therapist with an interest in the topics of symptomatic and idiopathic asymmetry, the occurrence of deformational plagiocephaly, the relationship between motor development and infants born preterm, and the difficulty of predicting future behaviors from current assessment. This is because the introductory and summary chapters provide a wonderfully relevant clinical context with outstanding lists of references. In addition, having all chapters in one place is very useful. Admittedly there are a few grammatically awkward moments and a few terms that are well defined but not completely congruent with American use. Nevertheless, I strongly suggest that this compilation of logical studies co-authored with a team of outstanding scientists belongs in a pediatric therapy or facility library. The topic is timely and well investigated. It also provides an excellent example of a scholarly doctoral investigation.

Jill Whitall, PhD Department of Physical Therapy & Rehabilitation Science University of Maryland Baltimore, MD

The Silent Child: Communication Without Words, by J Magagna ed., London, England: Karnac Books Ltd; 2012, softcover, 366 pages, ISBN-13: 978-85575-518-5, 34.94 Euros.

Magagna states that The Silent Child: Communication Without Words is written for parents and professionals to help them understand and deal with children having difficulty connecting and communicating with others—primarily their parents or closest caregivers. The specific type of communication disorder she focuses on is called “pervasive refusal syndrome” or “pervasive retreat from life,” describing children who for various psychological reasons have regressed in language and motor skills to the point of not speaking and in many cases not walking or eating.

This book contains 17 chapters, organized into 4 parts and includes a glossary and reference list at the end of the book. Chapters are written by the editor or contributing authors, all of whom have a background in psychology and intervention for children with this unique type of communication disorder.

Part I is an introduction to the text including 3 short chapters to get the reader acquainted with the main points of the book. Chapter 1, “The Sound of Silence,” written by Brian Lask, a Professor of Child and Adolescent Psychiatry at the University of London, explains that silence is not really noncommunication, but “rather a very loud and meaningful communication.” He describes how nonverbal communication in the form of body language, sighs, groans, laughs, sobs, and eye contact (or lack of it) are very real and strong ways of communicating. He uses “musing” as an example of how one might begin to develop a relationship with a child who becomes silent to understand his or her pain and reasoning behind becoming nonverbal. This is when you speak out loud what you think the child may be thinking and then wait for their response. In Chapter 2, “Milo Was a Normal Boy,” Milo's mother gives an agonizing account of her and her husband's battle to help their child Milo come out of his nonverbal retreat. It begins by explaining the sudden onset of Milo having some kind of unexplained illness where he cried out in pain saying things like “It hurts to talk,” and then he rapidly stopped talking, eating, and eventually walking—a retreat into himself. The account continues with his admission to Great Ormond Street Children's Hospital, where he was given the diagnosis of pervasive refusal syndrome, and treated for the next 2 years. Using psychotherapy, including the musing technique, family therapy, and various other treatments, he recovered completely. In Chapter 3, “Communicating Without Words,” Magagna describes her training in infant and child observation, giving examples of healthy intact parent-child relationship and communication, and less successful or dysfunctional interactions. She proposes children go through 5 states of mind when going into and out of silence, namely: giving up, being afraid, using adhesive identification, hatred and rage, and finally love and understanding. One of her main points in helping professionals and family members is training them to “put oneself in the shoes of the other person in the interaction” while exploring their own emotional experience. She develops this idea deeper and refers to it as countertransference.

Part II contains 4 chapters dealing with young children. In Chapter 4, Dubinsky, a child and adolescent psychotherapist in London, describes observations of parent-infant interactions from his practice. Using musing and countertransference, he hypothesizes how infants feel to explain their behavior with their mother: for instance, turning their body away from their mother (external world) because they are mad or jealous, internally thinking good thoughts about their mother (internal world), followed by turning back to their mother (external world) to re-establish the relationship. He feels babies do this reflective thinking and healing unconsciously. In Chapter 5, Magagna describes how family and environment can have a profound negative effect on the development of thinking and speaking, and how children may regress to nonspeaking when in a stressful negative situation. Magagna goes on in Chapters 6 and 7 to describe her method of treatment using family and individual psychotherapy. She emphasizes how important it is to engage the family as full members of the treatment team to help the child.

Part III deals with young people—namely older children and adolescents. In Chapter 8, Magagna states the importance of including extended family members in the therapy—especially siblings—encouraging exploration of “unspoken issues” through the use of dreams, drawings, and play. Great detail is given including specific questions to ask and techniques to use to help facilitate this. Sample drawings are included that show pictorial narrations of various children's family and life experiences to illustrate the effectiveness of this technique. In Chapter 9, Guuiny, a researcher in developmental adversity on attachment style and social processing, provides the story of Michael—a child diagnosed with pervasive retreat from life who was hospitalized due to not speaking, eating, or walking. The main point of her chapter is to educate and help staff and professionals working with children like Michael so they would not only be of help to the children but also to help themselves to become more understanding and more equipped to handle the challenging work. She emphasizes self-reflection and team work to support each other. Chapter 10 describes how physiotherapy intervention can lead to improved functional outcomes in children with pervasive retreat from life. Magagna and Bladen (a physiotherapist) describe “The Six C's” as the keys to developing the physiotherapist-child relationship. These keys are: Collaboration, Curiosity, Containment, Confidence, Creative Imagination, and Surprise. Bladen illustrates how keeping the therapy creative and new can provide pleasure and motivation for these children who are dealing with a lot of emotional pain. She also encourages therapists to examine their own feelings about themselves and the children they are working with to re-energize their passion for their practice. Chapter 11 is written by school teacher Sarah Dixon, describing her experience with children who do not talk, eat, or walk. To deal with her frustrations and to be more effective working with these children, she advocates teachers to write letters to the children, talking about their day, but never really giving these letters to the children, just writing them to practice self-reflection. In Chapters 12 and 13, Magagna and Bakalar (a psychoanalyst) discuss effective ways to deal with young children who have “failed” psychotherapy in the past, admonishing and encouraging therapists to not give up on these children and to be patient with them, remembering the importance of body and emotion countertransference. In Chapter 14, “A Journey Through Family Therapy With a Non-Speaking Child,” psychotherapist Cynthia Rousso shares how families are often challenging to work with due to evasion, projection, and hiding of feelings. Strategies are provided to overcome these difficulties. Chapter 15 describes the phenomena of “opaque silence”—when the silence of a child goes on for a long time and becomes deep and dark. Wood, a child psychiatrist, explains that even in this opaque silence, the child may be listening, processing, and working through the healing process.

Part IV, the final section of the book, is titled “Creative Activities for Non-Speaking Children.” Chapter 16, written by Tara Goldsmith and Naomi Simon, describes how they use group therapy in their hospital to promote symbolic and creative thinking. They foster group communication among the children by using theme based activities, such as drawing self-portraits, working with different materials, illustrating their name, or exploring the seasons. Chapter 17, “Roar and Rumpus: Engaging Non-Speaking Children Through Stories and Songs” shares how therapists use stories, music, poems, and creative writing to reach children and help them to emerge from their silence. It demonstrates how these media help foster empathy and sympathy. The theory of mindfulness is also discussed as a strategy for use with these children.

This book would be most helpful for professionals in the psychology field and for parents or family members of children with pervasive retreat from life. It may also be beneficial for speech and language pathologists, as it deals with a complex communication disorder. Physical therapists who have a special interest in children with this disorder or who work in a psychiatric facility may also find this insightful; however it would not be appropriate as a main physical therapy text, but rather as an optional special interest text. The chapter discussing physiotherapy would be the most useful chapter.

Deborah Nervik PT, DPT, MHS, DHS, PCS Department of Physical Therapy California State University Fresno Fresno, California

© 2013 Lippincott Williams & Wilkins, Inc.

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