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Book Review: Physiotherapy and Occupational Therapy for People with Cerebral Palsy
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Title: Physiotherapy and Occupational Therapy for People with Cerebral Palsy: A Problem-Based Approach to Assessment and Management

Authors: Karen J. Dodd, Christine Imms, and Nicholas F. Taylor
Publisher: Mac Keith Press 2010; Number of pages: 320
Reviewed by: Brigid Driscoll, PT, CO

This text is a resourceful guide for physical and occupational therapists, as well as other medical clinicians who provide care for individuals of all ages with cerebral palsy. The intervention process model, which is adapted from the Occupational Performance Process Model (Canadian Association of Occupational Therapists, 2002) is used throughout the text as a standardized guideline for patient evaluation and intervention. It is a patient- and family-centered tool that allows clinicians to systematically follow a clinical reasoning process that includes initial assessment, intervention, and final evaluation of outcomes. It is based on an eight-step process that ultimately should resolve the initial goals and concerns of the patient, family, and treatment team. These steps include:

  • Initial data collection.
  • Identifying concerns.
  • Identifying relevant theory.
  • Assessment of body structure/function, activity, and participation.
  • Identifying contextual factors.
  • Negotiating the management plan.
  • Implementation of plan.
  • Evaluation of outcomes.

The intervention process model is utilized in all of the case-based chapters to outline the individual treatment methods. In addition, the book presents a thorough overview of cerebral palsy and the complexity of this condition. There is a detailed description of the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) to better classify an individual's severity of impairment in respect to gross and fine motor skills while taking into consideration his or her environment. The importance of these assessment tools is emphasized by their utilization within the text for the case-based treatment methods to classify a patient's level of dysfunction.

One of the most enlightening chapters in the text revealed the family's perspective in caring for a child with cerebral palsy. As clinicians, this section of the book reminds us that, in addition to our physical evaluation and use of assessment tools, we need to listen to our patients' and families' concerns and needs in order to achieve outcomes that address everyone's goals. The importance of a family-centered approach while working with a multidisciplinary team is made quite clear throughout the text.

A general summary identifies commonly used physical and occupational therapeutic processes and interventions, such as neuro-developmental treatment (NDT), constraint-induced movement therapy, casting, and orthotic intervention. The book then transitions into 12 chapters of individual patient case studies and their specific treatment interventions. These chapters essentially describe in detail the different stages of the lifespan of an individual with cerebral palsy and proposed treatment plans for his or her current physical state. Some of the treatments described are for a severely involved infant with very complex needs, intervention for a young child with hemiplegia who underwent modified constraint-induced therapy, strength training for an adolescent with spastic diplegia, and long-term planning and care for a middle-aged woman with spastic quadriplegia. Based on these examples, it is evident how thorough the text is in presenting appropriate therapeutic care and intervention for individuals with cerebral palsy at any age.

In each of the chapters the intervention process model is outlined for each individual patient's needs in addition to GMFCS classification. Each case-based chapter makes use of appropriate assessment tools in order to validate and better assess the success of treatment outcomes. The appendix is a valuable resource and provides brief descriptions of the different assessment tools outlined in these chapters. The plan and implementation of treatment are presented, demonstrating areas that may include therapeutic, orthotic, environmental, and equipment intervention. Progression of these treatment strategies is also presented based on patient progress, and then final outcomes are evaluated.

In summary: Each chapter is systematically organized and provides a range of possible appropriate interventions specific to a variety of patients' physical, environmental, and emotional needs.

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