Physical Therapy in Public Schools, vol. 1, A Related Service.

Blossom B, Ford F. Roswell, GA 30077-1068, Rehabilitation Publications and Therapies Inc, 1991, paperback, 182 pp, illus, $45.

According to the authors, physical therapy services in public schools have grown rapidly since the implementation of federal mandates in the 1970s. This book was written to clarify the ongoing confusion and disagreement concerning what types of physical therapy should be administered and how school physical therapy should be provided.

This volume provides an overview of school physical therapy issues and practices, with an emphasis on students who have cerebral palsy. The preface indicates that volume 2 will address students with other disabilities; certain types of educational programs; and seating, positioning, and mobility.

Part 1 begins with an overview of a physical therapist's role in public schools and some of the educationally related problems of students who receive physical therapy. This overview is followed by a framework for referral, evaluation, determination of goals and objectives, intervention planning, and record keeping.

Throughout part 1, the authors emphasize the need to identify and focus on functional, educationally related, and realistic outcomes of school physical therapy. Their coverage of potential architectural barriers and other environmental barriers to students with motor impairments is especially informative and perceptive. They provided a School Environmental Profile, which is used to identify possible barriers in school buildings and could be useful to physical therapists who go to a number of schools on an irregular basis. The authors emphasize the importance of a good working partnership between the physical therapist and the student's teacher and parents, and provide sample forms to gather information from teachers, parents, and physicians. The sections on record keeping and risk management also provide helpful information and suggestions.

Although part 1 touches on issues that are important to the delivery of school physical therapy services, it does not grapple with the more difficult questions, nor does it cite or incorporate current related services or special education literature. There is no coverage of a collaborative team determination of students' goals, in which the physical therapist would contribute to the accomplishment of goals that have motor or mobility components, rather than establish goals. I also got a somewhat disturbing impression that these authors feel that physical therapists have an expert's role, where they need to help parents and teachers "understand why [they] plan as [they] do" and to help them have realistic expectations of the child.

Some of the important questions that remain unanswered in part 1 include: How is educational relevance determined? When should a child be referred to a physical therapist outside of school? What activities are appropriately carried out by other school personnel? What should be considered when teaching other adults? Where should therapy be provided? What are potential relations between various service delivery models and motor learning?

Motor and orthopedic aspects of cerebral palsy are both addressed and nicely illustrated in part 2. The "Gross Motor Skills" section deals almost exclusively with descriptions and functional influences of reflexes and postural reactions. The "Orthopaedics" section provides good, basic descriptions of common musculoskeletal problems and their resulting functional limitations.

Part 3, "Evaluations," begins with an important introduction of the need for evaluations that relate to functional and educational concerns. Evaluation of general functional skills, lower-extremity range of motion, posture, and gait are described, accompanied by evaluation forms that readers are invited to photocopy and use. The authors spend a considerable amount of time delineating a method to assign students to one of five "functional classes," an effort that does not seem particularly useful programmatically, and may provide just another label for students with disabilities. Published evaluation instruments were not addressed, other than giving some general precautions about the use of norm-referenced tests.

I had looked forward to reading this text, anticipating that it would serve as a state-of-the-art resource needed by both students and practicing school physical therapists. Even though the text does not meet this specific need, the general framework for school physical therapy, the evaluation forms, and the information provided concerning cerebral palsy could be useful for some physical therapists. In an attempt to answer the important and difficult questions related to the provision of school physical therapy, I would suggest that the reader do a personal review and synthesis of pertinent literature and legislation.

Irene R McEwen, PhD, PT, PCS Univ of Oklahoma Health Sciences Center Oklahoma City, Okla