Decision Making in Pediatric Neurologic Physical Therapy.

Decision Making in Pediatric Neurologic Physical Therapy

Campbell SK, ed. Philadelphia, PA 19106, Churchill Livingstone Inc, 1999, hardcover, 341 pp, illus, ISBN: 0-443-07923-4, $51.50.

The goal of the editor was to act as a facilitator for a group of experienced, scientific practitioners in a process of reflection and justification about how they make treatment decisions for a variety of children with neurological disorders. Each of the contributing master pediatric clinicians offers relevant case studies in which they elaborate on goal development, strategy selection, tactics for successful plans of care, and documentation of outcomes. It was their task to discuss how family members can be included in the decision making, what measures are the most appropriate, and how the choice of treatment strategies and techniques might be justified based on current theory and existing literature.

The opening chapter, written by Campbell, describes the hypothesis-oriented algorithm for clinicians (HOAC) in detail and discusses how this model fits with "best practice" options for pediatric service delivery. In chapter 2, the author elaborates on the program planning and treatment of a child with cerebral palsy. The reader is provided with a detailed case study that addresses all aspects of the therapeutic management of a child with cerebral palsy. Chapter 3 explores the therapeutic management of children with traumatic brain injury. Three case studies and a current literature review illustrate the decision-making processes involved in developing and implementing an appropriate plan of care for a child with a traumatic brain injury.

The focus of chapter 4 is on the child with severe cognitive impairments, deficits in function, and multiple associated impairments and disabilities. The author describes how physical therapists can be effective in the comprehensive assessment and treatment of a child with multiple disabilities. The chapter closes with a relevant case study and a list of resources for professionals and families. Myelodysplasia is described in detail in chapter 5. In this chapter, the author's goal was to provide the clinician with criteria to assist in developing an appropriate plan of care for a child or adult with myelodysplasia and to recognize secondary conditions that can develop as the child matures into adulthood. Case studies illustrate the problems commonly experienced by the clinician and the family. Chapter 6 addresses children with brachial plexus injury and includes many relevant illustrations that help illuminate the concepts related to examination, evaluation, intervention, and function in this clinical population.

Finally, chapter 7, also authored by Campbell, is concerned with the infant who is at risk for developmental disability. In this chapter, she uses 5 case studies to illustrate evidence-based decision making by the physical therapists treating these children. Numerous examination and screening tools are described in the case studies, including the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), the Dubowitz Neurological Assessment, and the Test of Infant Motor Performance (TIMP). In addition, several developmental assessments, such as the Bayley Infant Neurodevelopmental Screen (BINS), the Harris Infant Neuromotor Test (HINT), the Alberta Infant Motor Scale (AIMS), and the Movement Assessment of Infants (MAI), are mentioned for use in postdischarge assessment. A wonderful series of sequential illustrations complement information on examination, evaluation, and intervention for one of the case studies. "Reflection on practice" sections are provided following each of the case studies to help objectively evaluate the intervention and offer alternative approaches.

This text is wonderfully written; each contributing author writes in his or her own style but with a strong central theme of decision-making processes and evidence-based practice. Figures and tables provide schematic representation of some of the more abstract concepts, and the illustrations truly enhance the written text. Current literature reviews are included for each diagnosis, and the references are exhaustive.

The text is unique because it emphasizes the clinical decision-making process and, through multiple citations of current research, strongly encourages evidence-based practice. I highly recommend this text to all pediatric physical therapists and to therapists in any other related disciplines who work with children with neurological disorders. For therapists who have recently entered the field, this text provides a structured guide to begin to develop solid decision-making skills and embrace the concept of evidence-based practice.

Deborah E Thorpe, PhD, PT, PCS The University of North Carolina at Chapel Hill Chapel Hill, NC

Dr Thorpe is Assistant Professor in the Division of Physical Therapy. She conducts research on aquatic therapy and its effects on children with cerebral palsy and on the effects of cognitive strategies and types of feedback on motor learning in children with and without disabilities.