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Title: The Identification and Treatment of Gait Problems
in Cerebral Palsy

Editors: James R. Gage, MD; Michael H. Schwartz, MD; Steven E. Koop, MD; Tom F. Novacheck, MD
Publisher: Mac Keith Press; Number of pages: 625
Reviewed by: Phil Stevens, MEd, CPO, FAAOP

Cerebral palsy is one of the most frequently encountered and, frankly, more challenging patient populations in the field of orthotics. As such, any efforts to enhance one's ability to manage this population will lead to the provision of greater overall clinical care. Of the available resources for increasing your understanding of this presentation, there are none more comprehensive than this recent publication from Mac Keith Press. With a team of editors lead by the prolific James Gage, MD, 36 individual authors contributed to the body of the text.

The specific treatment of bracing is rather limited, comprising only a single 20-page chapter in a text of more than 600 pages. The authors of this section, including George Gent, CO, and Gary Kroll, CO, from Gillette Children's Specialty Healthcare, Minneapolis, Minnesota, provide a thorough review of the different AFO designs that might be utilized in this population, as well as when one might be chosen over another.

The strength of this text lies in its comprehensive discussions of elements outside of the bracing process. The book begins with an overview of normal neural control, musculoskeletal growth and development, and the resultant "normal" gait. This is followed by a broad discussion of the pathologic gait patterns and presentations observed in cerebral palsy, including the underlying causative mechanisms, the associated pathophysiologies, and their various impacts on musculoskeletal development and function. The third section is devoted to patient assessment techniques and considerations including manual muscle testing, range of motion measurement, neuroimaging, radiographic evaluation, and gait analysis.

The text then transitions from assessment to treatment, including individual chapters on such non-operative modalities as physical therapy, orthoses, and pharmacologic interventions. These are followed by thorough discussions of various operative approaches, such as intrathecal baclofen, selective dorsal rhizotomy, and a host of orthopedic procedures, including both soft tissue releases and bony restructuring procedures. The text concludes with a section on outcomes assessment.

In summary: This textbook is unlikely to serve as a cover-to-cover read for most busy practitioners; however, it may serve as a valuable reference resource for those practitioners interested in expanding their understanding of the current management of this complex patient population.

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