Teaching Motor Skills to Children With Cerebral Palsy and Similar Movement Disorders: A Guide for Parents and Professionals.

Teaching Motor Skills to Children With Cerebral Palsy and Similar Movement Disorders: A Guide for Parents and Professionals Martin S. Bethesda, MD 20817, Woodbine House, 2006, paperback, 237 pp, illus, ISBN: 1-890627-72-0, $19.95.

The goal of this book is to provide families of children with cerebral palsy (CP) and similar movement disorders with a clear, easy-to-read guideline for performing home exercise programs. Martin has done an excellent job in accomplishing this goal. The book is easy to read, has plenty of illustrative, referenced photographs, and is organized logically.

Chapter I begins with a description of CP and developmental delay. It describes, in nontechnical language, the different classifications of CP. It also explores other related difficulties that a child with CP may encounter.

Chapter 2 describes typical gross motor development. In addition to the usual description of the gross motor sequence, this chapter contains an excellent section explaining how a baby's position influences motor development (prone position helps to foster extension control, sidelying position might help the child bring hands to midline, etc). This is followed by a description of the typical pattern of motor development in a child with CP. This topic can be a difficult one to address and to make meaningful to the individual reader; the written information often is too clinical or not sensitive enough. By using the Gross Motor Classification System for Cerebral Palsy as a framework, Martin manages to simply and clearly describe possible outcomes for motor milestones and the ranges of abilities at different ages.

Chapter 3, "Obstacles to Motor Development," is an outstanding introduction to medical terms that parents will hear multiple times during physician appointments. This chapter describes the concepts of "tone," abnormal movement patterns, reflexes, motor control, and motor weakness. It also describes how these items complicate the acquisition of motor skills in a child.

Chapter 4 provides information on how parents and caregivers can help their child learn motor skills. It discusses some principles of motor learning in a way that parents will understand and provides an illustrated guideline to the necessary motor skills that are prerequisites for ambulation. This chapter also addresses how therapists may use different therapeutic approaches in teaching motor skills.

For a child with CP who experiences tightness, a consistent home stretching program is paramount in establishing a good physical baseline for strengthening and functional skills from which to work. Chapter 5, "Flexible Muscles and Joints," is devoted to this topic. Martin describes the possible muscle and joint problems that can arise from lack of range of motion, and she lists specific guidelines for performing exercises with this population. There are detailed descriptions and illustrations of every upper- and lower-extremity exercise. Throughout the text, the author emphasizes to the parent that the program should be established and monitored by the child's physical therapist.

The bulk of the remaining text contains 12 chapters that address a different skill, such as holding the head up, sitting, and standing. Each chapter describes activities to facilitate that particular skill. Essential portions of the exercise are illustrated with photographs and are clearly described in step-by-step instructions. All photographs are referenced in the text. Each skill is addressed not only with infants and toddlers, but with older children as well. Suggestions for integrating the activity into the home routine are included. At the end of each chapter is a section of frequently asked questions.

The concluding chapters address sports and community activities, orthopedic interventions (eg, bracing and Botox injections), and contact information for equipment vendors and associations serving children with CP.

I highly recommend this book for any new parent of a child with developmental disabilities. It provides parents with a clear description of what they can expect for their child's motor development in the years ahead. Not all therapists will agree with some of the behavioral approaches depicted; for instance, the author emphasizes that activities should stop if the child cries at all, whereas some therapists may argue that a child needs to be exposed to a difficult physical task repeatedly before the child will acquiesce to the activity. A similar situation exists in teaching a child to go to sleep at night or self-calm upon waking in the middle of the night. But all will agree that this book can foster communication and facilitate carry-through on home exercise programs in the pediatric population.

Carolyn Vaillancourt

C Vaillancourt, PT, NCS, is Neurological Clinical Specialist and Senior Therapist at Braintree Rehabilitation Hospital Pediatric Center in Braintree, Mass.

[DOI: 10.2522/ptj.2007.87.7.957]