Facilitating Development of Sensorimotor Function: Treatment with the Ball.

The author's purpose for writing this book is to share therapy techniques and strategies for using the gymnastic ball during treatment sessions. Her intent is to provide therapists with a review of the basics of movement control and to provide structure for using the ball as a therapy tool. All of the treatment examples contained in the book use children, although many of the activities could be applicable to and adapted for adults.

Over the past several years, some therapists have criticized ball therapy and have questioned its relationship to the development of skill, claiming that work on a movable surface does not lead to skill on a stable base. The author argues that use of the ball during therapy allows the therapist to focus on the component of movement required for skill and that working on these components on mobile and stable surfaces increases treatment options toward the goal of skill development. She also emphasis that the ball is only one tool available to therapists and that appropriate therapy should not be confined to one treatment technique.

The book is divided into 13 chapters. Each one is very well illustrated with line drawings. The first 4 chapters provide some basic introductory and background information for using the ball. Chapter 1 describes the characteristics of the ball as a therapy tool. Chapter 2 outlines goals that are considered to be prerequisite to skill development and that can be accomplished using the ball, including range of motion, joint mobility, muscle strength, synergistic activity, joint alignment, reaction to weight shift, and movement experience. This chapter establishes the format used in later chapters to outline ball techniques used for the achievement of these goals in different positions. Chapter 3, entitled "Ball Treatment and Muscle Tone," discusses how the ball can be used to manage muscle tone and promote a greater variety of movement patterns in clients with motor problems. The information in each of these first 3 chapters is quite rudimentary, with each one being only two to four pages in length.

Chapter 4, entitled "Balance Reactions and the Ball," address basic concepts related to balance and use of the ball to facilitate righting and equilibrium reactions. Differences between weight shift on mobile versus stable surfaces, the significance of extension and flexion with rotation for balance, and the basic components of balance and posture are discussed.

Chapter 5 through 10 describe and illustrate specific ball techniques that can be used to achieve components of movement in specific positions. These chapters cover ball techniques for goals in prone, supine, side-lying, sitting, kneeling, and half-kneeling positions, and during stance and gait. Each chapter follows the same format, dividing the activities into the functional goals outlined in chapter 2.

Periodically throughout the first 10 chapters, instructional notes and specific problems for the reader to solve appear in boxed, highlighted areas. The statement "Try This" also appears occasionally and is followed by activities the author encourages the reader to try to help clarify certain points.

Chapters 11 and 12 include case studies of children with hypotonia and spastic diplegia, respectively. Very detailed first-person accounts of a treatment session using the ball are provided for each case to illustrate the progression of treatment and transitions between activities. Chapter 13 is a short chapter promoting balls as a source of games and play activities for children. A list of terminology and references are included in the back of the book.

Individual skills are not emphasized in this book, nor does the text differentiate between treatment strategies for children with varying diagnoses. Rather, emphasis is placed on developing the components of movement that provide die basis for higher-level skills. It is left to the treating therapist to combine these components of control into whatever skill the patient can achieve.

Pediatric physical therapy practitioners, especially those new to the field of pediatrics, would find this book a practical and useful reference. The inclusion of instructional notes and problem-solving activities make this book appropriate for physical therapy educators and students of physical therapy as well.

Gretchen Meyer, PT IPMR/Easter Seal Rehabilitation Center Peoria, Ill

Ms Meyer is an area supervisor and early intervention specialist at IPMR/Easter Seal Rehabilitation Center. She specializes in the treatment of infants and young children, and in the assessment and provision of seating and mobility systems for children and adults with neuromotor and developmental disabilities.