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Treatment of Cerebral Palsy and Motor Delay

by Sophie Levitt FCSP. Blackwell Scien- tific, Oxford (3rd edn ) 1995 (ISBN 0 632 03873 X). Illus. 341 pages. f19.99.

There are ten chapters of which two are new in this, Mrs Levitt’s third edition of Treatment of Cerebral Palsy and Motor Delay. (The second edition was published in 1982.)

The essence of each ‘treatment system’ is given by the author in ‘Synthesis of treatment systems’ and ‘Outline of treatment app- roaches’. A detailed summary of each is given.

Mrs Levitt feels that ‘as it is diffi- cult t o confine oneself to any particular system and as each has made valuable contributions, an, eclectic approach is recommended’. I am not convinced! How can treat- ment techniques from a variety of ‘origins and schools of thought’ result in a cohesive treatment programme?

The two new chapters discuss ‘Learning motor function’ and ‘A collaborative learning approach’. These focus on children with ‘move- ment difficulties’ being ‘taught’ motor tasks. The latter chapter gives an analysis of the importance of parental/family/professional in- volvement,

‘Treatment procedures’ has 154 pages. I feel that two or three shorter chapters would have been better than one. The early part of this chapter discusses our role with a ‘severely visually impaired child‘. This is written in a sensitive, prac- tical and realistic way.

However, a large part of ‘Treat- ment procedures’ presents as ‘treatment recipes’, rather than ‘problem solving’. These recipes ignore the fact that each child with ‘motor difficulties’ is an individual, with individual needs, requiring individual assessment and treat- ment.

The book’s print is larger and easier t o read than of the second edition.

However, the following changes would make the book more pres- entable, and clearer, as a textbook:

(a) Old photographs which are no longer useful, were removed. edition.)

photographs are from the second

(b) New photographs which are too small, too dark and altogether unclear, were removed. (c) Many more clear line drawings were added to all of the chapters.

The layout of the book lends itself nicely t o drawings being added to the margin of each page.

Overall, I find the book rather disappointing. I t includes out-of- date photographs, pictures of equipment without children, or of inappropriate equipment such as a ‘crawler’. (A large number of

However, I do think that this book should be in each paediatric physiotherapy library. Its contents, good and bad, will certainly stimu- late conversation and debate.

I would consider this a book for experienced physiotherapy staff with regard t o the whole text. Students and junior staff should perhaps be given guidance regarding specific chapters in the book.

Yvonne Robson MCSP

Muscle Energy Techniques by Leon Chaitow. Churchill Livingstone, Edinburgh, 1996 (ISBN 0 443 05297 2). 160 pages. f23.50.

This book appears to be a develop- ment of some of the material published in Chaitow’s Soft Tissue Manipulation. Essentially, this new book discusses some aspects of muscle imbalance and describes the muscle energy technique (MET) method of correcting muscle short- ening.

The book appears to be written primarily for ‘bodyworkers’ - manual therapists of all back- grounds. The terminology used is often osteopathic based - for example, concepts of tissue resis- tance and end-feel (of passive movement) are described as ‘ease and bind’ but the principles are familiar to physiotherapists.

I t begins with an interesting historical trace of MET’S origins although there is some minor confu- sion here between proprioceptive neuromuscular facilitation (PNF) techniques using spiral patterns and the isometric hold-relax method. The text touches on issues of muscle imbalance, currently popular in physiotherapy, and discusses Lewit’s and Janda’s work, particularly Janda’s theories asso- ciated with tight postural muscles, reflex inhibition of antagonists, and cross-patterning. Chaitow also mentions the effects of muscle imbalance on altered fibre type.

Liebenson’s contributing chapter covers altered movement patterns but there is little reference to altered recruitment patterns or altered spinal stabilisation and the relevance of this to exercise prescription. Sahrmann’s work is notably missing.

The book covers a lot of ground through an examination of previous work, but extensive use of quota- tion interrupts the flow of discussion. The sequential assess- ment, treatment of the main postural muscles, and the appli- cation of MET are well described and the inclusion of myofascial trigger points is welcomed. The style adopted throughout this book whereby the text is based on the work of other authors, results in it being divided between theories and literature rather than concepts and princi- ples. This makes i t more difficult for the reader to develop a logical flow of thought about the subject. I t would have been enhanced by a firmer base on principles such as assessment.

The book is attractive with useful diagrams - although almost all the models and therapists are white men. It is a useful reference for users and students of MET, focusing on an important aspect of current muscle imbalance theory and prac- tice.

Liz Holey MA MCSP DipTP

Physiotherapy, August 1996, vol82, no 8

book reviews