Treatment of Cerebral Palsy and Motor Delay

462 Pages·2019·24.43 MB·english

by  Anne Catherine Addison

Treatment of Cerebral
Palsy and Motor Delay
Treatment of
Cerebral Palsy
and Motor Delay
SIXTH EDITION
Sophie Levitt
BSc (Physiotherapy) Wits
Fellow of the Chartered Society of Physiotherapy
Honorary Member of the Association of Paediatric Chartered Physiotherapists
Consultant Paediatric Physiotherapist, London
Anne Addison
MSc BSc Occupational Therapy MRCOT
Clinical Lead Occupational Therapist
The Wolfson Neurodisability Service
Great Ormond Street Hospital for Children, London
This sixth edition first published 2019 © 2019 Sophie Levitt and Anne Addison
Edition History [John Wiley and Sons 5e, 2010]
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Library of Congress Cataloging‐in‐Publication Data
Names: Levitt, Sophie, author. | Addison, Anne (Anne Catherine), author.
Title: Treatment of cerebral palsy and motor delay / Sophie Levitt, Anne Addison.
Description: Sixth edition. | Hoboken, NJ : Wiley-Blackwell, 2019. | Includes bibliographical
references and index. |
Identifiers: LCCN 2018025070 (print) | LCCN 2018026692 (ebook) | ISBN 9781119373889 (Adobe PDF) |
ISBN 9781119373599 (ePub) | ISBN 9781119373865 (pbk.)
Subjects: | MESH: Cerebral Palsy–therapy | Child | Motor Skills | Motor Skills Disorders–therapy |
Physical Therapy Modalities | Adolescent
Classification: LCC RJ496.C4 (ebook) | LCC RJ496.C4 (print) | NLM WS 342 | DDC 618.92/83603–dc23
LC record available at https://lccn.loc.gov/2018025070
Cover design: Wiley
Cover images: © FatCamera/Getty Images; © jarenwicklund/iStockphoto; © olesiabilkei/iStockphoto
Set in 10.5/12.5pt Minion by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
Contents
Foreword ix
Preface xi
Acknowledgements xvii
1 The clinical picture for therapy and management 1
Incidence of cerebral palsy 1
Motor dysfunction 1
Associated impairments and disabilities 3
Broad framework for therapy and management 4
Aetiology of cerebral palsy 7
Genetic causes 7
Causes in later childhood 7
Neuroimaging 7
Clinical picture and development 8
Change at different ages 9
Classification systems 11
Topographical classifications 14
Classification of motor types of cerebral palsies 15
Common features observed in all presenting types of cerebral palsies 21
Motor delay 22
Summary 23
2 A collaborative learning approach 25
Working with parents within a family framework 25
Emotional support 26
Parents vary 27
Other adults 28
Family‐centred services 28
Research on home and school visits 30
Collaborative learning approach 30
Opportunities to discover what the parents and child want to achieve 31
Opportunities to clarify what is needed for these achievements, to recognise
what parents and children already know and can do, and to find
out what they still need to learn and do 32
Involvement in the selection and use of methods 34
Involvement in the evaluation of progress 37
Parent–child interaction 38
Helping a child to learn motor control (body function) and motor function (activity) 39
Observation of parent and child interaction 40
Social needs 41
Parents’ health 41
Teamwork with parents 42
v
vi Contents
Siblings 43
Alternative and complementary treatments 44
Summary 46
3 Learning motor function 49
Learning methods 50
Development of a child’s attention and learning 52
Practical ideas to promote attention and learning 53
A child’s own strategies for a chosen goal 54
Task analysis 55
Cues for learning 56
Verbal guidance 58
Rewards 58
Practice and experience 59
Summary 60
4 Adolescents and adults 61
Studies of function in adolescents and adults 62
Activity goals 63
Issues of concern for adolescents and adults 64
Adolescents 65
Adults 66
Healthy lifestyle 67
Develop appropriate community mobility 68
Training of self‐care and cosmetic appearance 69
Knowledge about the condition 69
Therapeutic activities 70
Measures 70
Summary 70
5 Outline of treatment approaches 71
History 71
Muscle education and braces 71
Progressive pattern movements 73
Proprioceptive neuromuscular facilitations (PNF) 74
Neuromotor development 75
Neurodevelopmental treatment (NDT) (Bobath approach) 75
Sensory stimulation for activation and inhibition 77
Reflex creeping and other reflex reactions 78
Conductive education 79
Sensory integration 81
Context therapy 82
Strength training 82
Systems‐based task‐oriented approach 87
Mobility Opportunities Via Education (MOVE) 88
Contemporary theories 89
6 Evidence‐based practice 93
Research and clinical studies 93
Research on treatment approaches 93
Theoretical grounds 94
Research studies 94
Reviews of research studies 94
Research on specific procedures 95
Contents vii
Other research 95
Clinical experience with evidence‐based practice 96
Definitions 97
The appraisal of research studies for therapy 98
Examples of qualitative research methods (Greenhalgh and Taylor 1997) 102
7 Synthesis of treatment approaches 103
The eclectic viewpoint in therapy 103
Synthesis of treatment systems 104
The postural mechanisms 105
Trunk control 108
Voluntary motion 108
Perceptual–motor function 110
Principles for a synthesis of therapy and management 110
Developmental training 111
Some advantages and disadvantages of modifications of developmental sequences 114
Treatment of atypical tone 116
Training of movement patterns 117
Use of afferent stimuli 118
Management of deformity 120
8 Assessment for therapy and management 121
Approach to assessment 121
Assessment and measurements 125
Examples of atypically persistent postures, movements, and functions 132
Functional measures 133
Specific functional items 135
Measures of upper extremity and hand function 137
Measures of daily activity and participation 138
Quality of life and health‐related quality of life measures 142
Norm‐referenced measures of stages of child development 143
Neonatal assessments 144
Methods of observation of gait 145
Additional assessment required 154
Records 155
Summary 156
9 Treatment procedures and management 157
Motor training 157
Development of the child with severe visual impairment 161
Developmental Training 168
Prone development 168
Supine development 193
Development of sitting 208
Development of standing and walking 230
Lower limb orthoses for standing and walking 263
Development of hand function 277
Techniques for carrying the child correctly 307
10 Function and the child’s daily life 309
Motor function in communication 310
Motor function in self‐care activities 313
Motor function for leisure 326
viii Contents
11 Therapeutic group work 329
General management of groups 331
Selection of children 332
The programme 333
Summary 335
12 Management of deformities 337
Causes of deformities 338
Therapy goals 343
Deformities and gait 344
General considerations related to surgery 348
Therapy and daily care 351
Dynamic arm deformity 365
Deformities of trunk and neck 365
13 Assessment, prescription, and provision of equipment 367
Equipment for self‐care tasks 368
Postural management equipment 370
Sleep systems 381
Other equipment for positioning 383
Mobility equipment 383
Adaptations and the built environment 391
Appendix 1 Developmental levels 393
Physical ability assessment guide 393
Wheelchair use 397
Appendix 2 Useful organisations 399
References 401
Index 429
Foreword
It is a pleasure to welcome the sixth edition the practical principles of assessment, the
of this book. It is the distillation of the ranges of treatment approaches and their
knowledge and practice of two distinguished indications, and the relationships of these to
therapists who have wide experience in all function and activities of daily life. They
aspects of evaluating and treating children rightly emphasise the importance of enabling
and young people with motor disorders, children and their families and also of pro-
particularly cerebral palsy. The authors’ moting their societal participation as basic
approach is based on a modern under- tenets of the work of therapists in this field.
standing of what constitutes cerebral palsy, It is also helpful and appropriate in a
on the range of associated impairments book of this nature that the authors help-
that may be seen, on its natural history as fully discuss the expanding scientific back-
affected children move into adult life, and ground that underpins our understanding
on the range of relevant interventions that of cerebral palsy, including how evidence
can be applicable. can be evaluated and what can realistically
The authors have a clear understanding be researched in children who have a wide
of historical approaches to treatment but variety of neurological impairments. What
have moved on from these to detail the they have successfully achieved is to com-
need for evidence-based practice so far bine this approach with clear views on the
as this is possible, and they rightly also practical interplay that experienced practi-
emphasise the requirement to work collab- tioners in a multidisciplinary team need to
oratively with children and their families utilise when setting priorities for an indi-
and to base their aims and approaches on vidual child within the context of his or her
the World Health Organization’s current family.
International Classification of Functioning, This book remains essential for those
Disability and Health. managing children with disability.
For those involved, as either therapists or
parents, in understanding, planning, provid- Dr Lewis Rosenbloom
ing interventions, and understanding and Honorary Consultant Paediatric Neurologist
monitoring their effectiveness in motor dis- Alder Hey Children’s Hospital
orders Sophie Levitt and Anne Addison have Liverpool
systematically taken their readers through UK
ix
Preface
The sixth edition of this book reflects and their family. It was not always easy to
where we have been and where we are now. incorporate their essential messages into
Ideas are currently from both physiother- our therapy as there are contradictions
apy and occupational therapy as there are in  the cultures of different disciplines.
two co‐authors. Ideas from the past are still However, we have drawn on their funda-
prevalent today, but we fortunately have mental concerns for whole individuals and
more studies that confirm the value of tried to integrate them into the develop-
some of them. Research on others may not ment of their abilities.
be easy or perhaps possible at this time. In The first edition of this book (Levitt
order for this book to reflect both what we 1977) originally proposed an eclectic
did and what we do now, we have learned approach drawing on topics in neurology,
from therapy colleagues and especially orthopaedics, and typical and atypical child
from the parents and families of children, development. This was challenging, as it
adolescents, and adults with cerebral palsy. involved dealing with contradictory
Listening attentively to these individuals, views in physiotherapy for cerebral palsy.
we have learned of their fundamental Common ground was found between dif-
human needs for respect, for support, and ferent therapy approaches and formed the
for a sense of control of their lives. Their basis of an eclectic approach. Mantovani
practical ideas, their courage, and their and Scrutton (2014), in their chapter
determination to do their best are inspir- ‘Historical perspective’ in Cerebral Palsy:
ing. Parents and their children with disabil- Science and Clinical Practice, quote this
ities taught us that they needed empathy proposal of an eclectic approach by Levitt
not sympathy. How does one present ther- (1977). Since publication of earlier editions
apy in this style? Did we have adequate pro- of this book it has been rewarding to find
fessional knowledge to warrant the trust of an increase in an eclectic viewpoint and in
parents, their children, adolescents, and more functional physiotherapy, which were
adults with cerebral palsy? so frowned upon in the past.
Fortunately, we had, and still have, con- Our eclectic approach draws on the
tact with many professionals in medicine, in Bobath approach, as well on many other
therapy, including speech and language approaches and therapy tools. The review
therapists, in education, in psychology, and of interventions for cerebral palsy by Novak
in social work. This was as members of mul- et al. (2013) seriously disapproved of
tidisciplinary and interdisciplinary teams in the neurodevelopmental treatment/Bobath
clinical work, schools, and postgraduate approach. However, their review provoked
education. We are grateful to the many dif- considerable controversy and, in particular,
ferent professionals in various countries Mayston and Rosenbloom (2014) pointed
who have given generously of their knowl- out that the interventions range from sys-
edge and helped us to understand their tems (such as Bobath) to specific proce-
views for the benefit of the whole person dures (such as selective dorsal rhizotomy),
xi
xii Preface
which are hardly comparable, and that the their parents, carers, and teachers in differ-
‘traffic light’ system used to rate the inter- ent communities. This promotes inclusion
ventions is oversimplistic. They also in mainstream schools and in the specific
highlight that the review was unable to cultural communities in which a child or
make recommendations for intervention older person finds themselves. The collab-
on the basis of age, Gross Motor Function orative approach is a learning process that
Classification System level, or type of cere- can allow parents and others involved to
bral palsy. learn at their own pace, so adjusting their
In previous editions, there was always expectations and attitudes while maintain-
the recognition that children ‘do not move ing hope.
by neurophysiology alone’ but that learning
processes enable a child to progress through Adolescents and adults. The fourth and
stages of gross and fine motor develop- fifth editions suggest the use of the frame-
ment. The second and subsequent editions work of the collaborative learning approach
continued to include and elaborate learn- with the older person (adolescent or adult)
ing principles to develop children’s motor with cerebral palsy. The sixth edition dis-
function. Functional therapy grew out of cusses differences between adolescents
the question: ‘How do parents and other and adults, and what is common to both
adults learn?’ Studies in adult education age groups. Similarly, as with children and
showed that people learn best what has parents, it offers mutual respect between
meaning for them in their daily lives. individuals and therapists and develops
Parents were clearly motivated to improve self‐esteem and confidence in these indi-
their child’s daily function, which was so viduals. Meaning is given by the proce-
limited by cerebral palsy. dures suggested for their participation in
The third edition contained a spe- their daily life. Recreational therapeutic
cific chapter on a collaborative learning activities are included to add to their
approach. This had developed over some health‐related quality of life.
years for working with parents, carers, and
others involved with a child with cerebral Family‐centred approach (care). This is also
palsy. This ‘client‐centred’ approach based on the ‘client‐centred’ practice first
depends on their participation in a learning originated by Carl Rogers in the 1960s,
process. Unlike some learning models, this which formerly inspired the earlier collab-
model also includes the therapist’s own orative learning approach published in
participation in learning, as well as the 1990. Family‐centred physiotherapy and
emotional issues affecting learning of par- occupational therapy emerged in 1998 and
ent and therapist in collaborative work. in recent years. This approach involves all
This approach involves consideration of the members of a cerebral palsy team and is
the views and needs of both of them. a welcome development. However, in some
This approach develops respect for a places, this demands reflective learning
family’s cultural and social values learned and re‐examination of long‐held profes-
in Levitt’s experience in developing coun- sional attitudes. ‘We are doing this anyway’
tries and as a tutor/guest lecturer with is often felt by genuinely well‐meaning pro-
international students in the Community‐ fessionals, but given the new measures of
Based Rehabilitation Courses, Institute of what parents and families really experience
Child Health, London, UK. The collabora- from a service there is not necessarily
tive learning approach depends on daily agreement with this statement. References
tasks chosen by people with disabilities and to such measures are given in this edition.