Early Diagnosis and Interventional Therapy in Cerebral Palsy: An Interdisciplinary Age-Focused Approach (Pediatric Habilitation) PDF
Preview Early Diagnosis and Interventional Therapy in Cerebral Palsy: An Interdisciplinary Age-Focused Approach (Pediatric Habilitation)
ThepreviouseditionwaspublishedasEarlyDiagnosisandTherapyinCerebralPalsy: APrimeronInfantDevelopmentalProblems,SecondEdition,RevisedandExpandedby AlfredL.ScherzerandIngridTscharnuter. ISBN:0-8247-6006-9 Thisbookisprintedonacid-freepaper. Headquarters MarcelDekker,Inc. 270MadisonAvenue, NewYork,NY10016 tel:212-696-9000;fax:212-685-4540 EasternHemisphere Distribution MarcelDekkerAG Hutgasse4,Postfach812,CH-4001 Basel,Switzerland tel:41-61-261-8482;fax:41-61-261-8896 WorldWideWeb http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the headquarters address above. Copyright (cid:211) 2001byMarcelDekker,Inc.AllRightsReserved. Neitherthisbooknoranypartmaybereproducedortransmittedinanyformorbyany means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from thepublisher. Currentprinting(lastdigit): 10 9 8 7 6 5 4 3 2 1 PRINTEDINTHEUNITEDSTATESOFAMERICA Preface to the Third Edition HowsurprisingtorecallthatthefirsteditionofEarlyDiagnosisandTherapyin Cerebral Palsy was published in 1982. With the tools then available, clinical focus on diagnosis of the very young child seems, in retrospect, more a hope than a serious endeavor. Yet the volume was well received and led to a second edition in 1990. The interim changes reflected more experience with the very young child, and a shift in focus, away from the older established schools of therapy toward more activist, invasive treatments. Preparing the third edition has revealed truly remarkable changes. These changesarereflectedinaslightrevisionofthetitle.Fundamentalresearchatthe molecular and cellular levels has advanced our understanding of mechanisms involved in etiology and epidemiology. Developmental neurology has extended ourunderstanding ofnormalandabnormalbehavioroftheearly preterminfant. Screeningandassessmenthavebecomemoresophisticated,withanexponential increaseinthenumberofstandardizedinstruments.Thedevelopmentalscreening and evaluation process has matured considerably, with the availability of very sensitiveneuroradiologictools.Theaccumulationofclinicalexperiencewiththe veryyoungchildhasenabledamoredirectedapproachtoinfantdifferentialdiag- nosis. Interventionaltherapyhasalsomovedforward in manynewanddifferent directions. Therapy has become oriented more toward a dynamical systems ap- proach,emphasizingfunctionalchange,andmaintainingphysiologicalcondition- ing. Advances in the use of botulinum toxin, intrathecal baclofen, and selective dorsal rhizotomy to reduce spasticity have taken center stage, without uniform iii iv Prefacetothe ThirdEdition criteriaforeitherindividualorsequentialapplication,orclearevidenceoflong- termeffects.Cerebralpalsyhasincreasinglyfounditselfaprimetargetforalter- native treatments during this era. Perhaps the most startling innovation in the decade since the last edition hasbeenadvancesinresearch.Outcomesresearch,includinganindicationofthe strengthofevidence,hasemergedinthisperiod,andhasjustbeguntoinfluence the field of cerebral palsy. This third edition reflects these dramatic changes. We focus on the infant from birth to three years in order to highlight specific concerns about diagnosis and treatment in this group. This approach provides a model for dealing with older age group categories as well. It is apparent that an understanding of how to deal most effectively with the individual with cerebral palsy can best be ap- proached through consideration of the options for the specific age group in- volved. The authors comprise a truly interdisciplinary group that has worked to preparethisvolumeinmuchthesamecollaborativewaythattheywouldtotreat aninfant withcerebral palsy. Weallfeel itisa privilege tobring forwardthese important changes in the field at the start of a new century. Alfred L. Scherzer Preface to the Second Edition The first edition of Early Diagnosis and Therapy in Cerebral Palsy, issued in 1982, sought to fill a major need for professionals in bringing together in one source comprehensive information regarding diagnosis and management of the veryyoungchildwithcerebralpalsy.Atthesametime,wehopedtodemonstrate howthisframeworkmightserveequallyindevelopingprogramsforothertypes of nonprogressive deficits with similar needs. That we succeeded in filling this gapiswellillustratedbythewideuseofthistextovertheyearsanditscontinued demand by a variety of professionals. Intheyearssincetheoriginalissue,therehavebeenmanynewandexciting developments in the field. Among these of major interest are new approaches to early screening and identification, refinements in concepts and approaches to therapy, considerations of alternative surgical approaches to treatment, and an explosion in early intervention strategies increasingly based more on an educa- tional than on a traditional medical model. Clearlythetimehascometoincorporatethesedevelopmentsintothistext whichhasfoundmuch favorwithourcolleagues. Wethereforetakepleasurein bringing forth this second edition with the hope that it will continue to fill the needsofthosedevotedtothecareofthehandicappedchildinthisever-changing field. Alfred L. Scherzer Ingrid Tscharnuter v Preface to the First Edition Untilrelativelyrecentyears,cerebralpalsywasprimarilyofprofessionalinterest toalimitednumberofspecialistsdealingwithspecificaspectsoftreatment,such as orthopedics and neurology. Indeed, these are the specialties which initially shapeditsdefinitionandscope,datingfromthedaysofLittleandFreud.Children cametoattentionlate,whensignificantlimitationsindevelopmentandmilestones were noted, or severe orthopedic deficits were apparent. Intervention was fre- quentlyconcernedwithstaticneurologicassessment,andtreatmentoftenexclu- sively focused upon orthopedic surgery or a form of limited individual muscle therapy. The approach was to deal with the specific functional deficits as they appeared. A much broader concept has subsequently emerged with the awareness that cerebral palsy represents a major multidisciplinary developmental disorder inwhichtimelyinterventionbyavarietyofspecialtiesisessential,andacoordi- nated, directed approach is required. In addition, traditional therapy involving individual muscle training has given way—mostly through clinical work with cerebral palsy—to a more comprehensive and dynamic approach of movement educationwhichemphasizesthesensorimotordualityandisthereforeconducive tolearningnewmotorskills.Clinicalexperiencewithcerebralpalsyhasalsopro- motedanexpansionintheunderstandingofsensorimotordevelopment.Today,ab- normalmotorbehaviortypicallyassociatedwithcerebralpalsyisseenastheout- comeofalongprocessofpostural compensationstounderlyingdeficits,suchas abnormalposturaltonusorpoorintegrationofposturalreflexes.Whileearlyand primaryposturalcompensationsconsistofmoresubtledeviationsfromthenorm, motorskillsbuildingonthesedeviantpatternsbecomemoreandmoreabnormal. vii viii PrefacetotheFirstEdition Newerknowledgeconcerninginfantdevelopmentandrecognitionofearly common findings among infants with nonprogressive central nervous system deficits has now placed cerebral palsy within the spectrum of major develop- mental disabilities. In fact, its early identification and management presently serve as a model for other types of multiply handicapping conditions. Recent perinatal management and neonatal intensive care technologies havefurtherinfluencedtheoutlookforthechildwithpotentialdisability.Children are now surviving who until recently had an abysmal prognosis. Evidence indi- catesareduction,aswell,indegreeofdisability,althoughanincreaseinseverity issuggestedespeciallyamongthosehigh-riskandlow-birth-weightinfantswho formerlydidnotsurvive.Itseemslikelythatchronicdevelopmentaldisordersin children are destined to be a major and increasing concern for pediatrics of the future. It is in this setting that the concepts of early diagnosis and intervention have taken root and a sizable literature has emerged. Current data are clinically supportive of early intervention and the notion is intuitively appealing on the basis of developmental theory. An explosive interest has been generated in this field,yetthereisapaucityofsourcesavailableforcomprehensivereferenceand documentation. The present text attempts to fill this gap by putting into perspective the evolution of cerebral palsy from a narrow focus as an orthopedic disability to a broadly conceived developmental disorder. The emphasis is on the process of developmentaldiagnosis,andcurrentclinicalapproachestoevaluation,manage- ment,andtreatmentaredetailed.Theneedforcontinuous,systematic,andstan- dardizedre-evaluationisstressed.Suggestionsaremadefordevelopingresearch methodswhichwillultimatelyleadtoestablishingtheeffectivenessofanygiven treatment approach. It is hoped that the text will provide a useful guide for those who deal withawidevarietyofdevelopmentaldisabilitiesinyoungchildren.Considerable emphasis is placed on identifying early patterns of postural maladjustments so thattheycanbecorrectedasfaraspossiblebeforeleadingtomoresevereabnor- malities. Its focus is to provide a more uniform and standardized approach to diagnosisandtreatment.Onlyinthiswaywillitbepossibletoobjectivelyevalu- ateandguideindividualtherapyactivities.Ultimately,thiswillgreatlyaidinthe muchneededquestforresearchmethodologiesandfirmdataconcerningtheearly intervention process. Alfred L. Scherzer Ingrid Tscharnuter Contents Preface to the Third Edition iii Preface to the Second Edition v Preface to the First Edition vii Contributors xi 1. History, Definition, and Classification of Cerebral Palsy 1 Alfred L. Scherzer 2. Trends in Etiology and Epidemiology of Cerebral Palsy: Impact of Improved Survival of Very Low-Birth-Weight Infants 27 Vidya Bhushan Gupta 3. Diagnostic Approach to the Infant 49 Alfred L. Scherzer 4. Management and Treatment Planning for the Abnormally Developing Child 95 Alfred L. Scherzer 5. Historical Perspective to Current Practice: Habilitative Services 121 Margaret J. Barry ix x Contents 6. Clinical Assessment of the Infant 139 Gay L. Girolami, Diane Fritts Ryan, and Judy M. Gardner 7. The Written Assessment, Treatment Planning, and Intervention Strategies 185 Gay L. Girolami, Judy M. Gardner, and Diane Fritts Ryan 8. Treatment Implementation, Reassessment, and Documentation 207 Gay L. Girolami, Diane Fritts Ryan, and Judy M. Gardner 9. Assessment and Treatment Planning: A Case Study 229 Gay L. Girolami, Diane Fritts Ryan, and Judy M. Gardner 10. Research in Cerebral Palsy: Yesterday and Today 267 Charlene Butler 11. Evidence Tables and Reviews of Treatment Outcomes 285 Charlene Butler 12. Future Perspective on Cerebral Palsy 331 Alfred L. Scherzer, Charlene Butler, Vidya Bhushan Gupta, Margaret J. Barry, Gay L. Girolami, Diane Fritts Ryan, and Judy M. Gardner Index 347
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