Viva La Fra.

Tosti FT, prod. University of Maryland at Baltimore, Baltimore, MD 21201-1082, Video Press, 1992, VHS, 52 min, $400.

Viva La Fra is the case study of a 17-year-old girl who received head trauma in a serious automobile accident. The videotape opens with the call to the dispatch operator for the emergency medical team and then follows Fra from the scene of the accident, via helicopter, to the neurotrauma intensive care unit. There, the viewer learns of the various procedures and tests that are ordered by the neurosurgeon and his impression of her problems, gained through interview. Fra's nurse in the intensive care unit relates her basic responsibilities in caring for Fra and how the family reacted when she brought them in to see Fra for the first time. In the first of many interviews, the mother relates how frightening the first 4 weeks were and how the family learned to live minute by minute as they moved from one problem to another. The neurosurgeon, the nurse, and the mother all give their perspectives on the difficulty of making the choice of how aggressive to be with intervention. The mother says that their family was unanimous in wanting the medical team to "Go for it!"

The speech therapist is involved quite early in Fra's care and describes how Fra began to respond with simple eye opening after sensory stimulation and how he assumed the role of the "cheerleader" during the regular family conferences. The physical therapist is shown doing postural drainage with Fra, doing a total-assist transfer from bed to chair, and working on sitting balance. The use of the Ranchos Los Amigos scale based on cognitive measures is described.

Fra is followed from the intensive care unit to regular inpatient care, to a rehabilitation center, and finally home with outpatient services. Footage of Fra participating in various therapy sessions and interviews with key personnel at different stages highlights the roles of each profession and how those roles change as Fra's condition improves and she moves from setting to setting.

The physical therapist addresses how, at the rehabilitation center, Fra loved school and working on the computers but how difficult and frustrating physical therapy was for her. The psychologist on the team intervened, subsequently improving the communication between Fra and her physical therapist, and helping Fra identify goals toward greater independence that improved her motivation to work in physical therapy.

One sees the cognitive testing done by a neuropsychology fellow and the importance he conveyed to Fra, her family, and other team members of Fra's assisting in the transition from a passive recipient to an active decision maker and initiator. Highly specialized intervention strategies are illustrated by the speech and language consultant who uses biofeedback from a voice analysis computer, and a dental specialist who designs a prosthetic palate and lip for Fra to improve articulation.

When asked what title she would give this phase of her life if she were writing an autobiography, Fra's response, "Smooth Sailing," highlights the very positive attitude that underlies the whole story. The title of the videotape comes from final reflections by the mother, "The human spirit is stronger than anything you can hold in your hand. Viva la Fra!"

The videotape is an excellent, accurate, and up-to-date overview of the various health care professions and their functional roles as part of a team process. The production quality of the videotape is generally very good, and, although lengthy (52 minutes), the tape includes sufficient variety and scope to keep the viewer's interest. The producer of this videotape happened to see Fra when she was admitted to the neurotrauma unit and was immediately interested in documenting her story. As a result, the footage is actual segments of various treatment sessions and real interviews, not just reenactment of scenes for the purposes of telling the story.

The most appropriate audiences are probably high school and college students who are exploring various health occupations or entry-level students in any of the health-related fields. It would be interesting, but not particularly educational, for the practicing professional, as there is not enough depth in any one area.