The authors are so pleased to provide present and future physical therapists with a new, totally updated edition of Meeting the Physical Therapy Needs of Children. Our diligence and risk in using the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001) in the first edition has been rewarded with nationwide acceptance of this conceptual model that has formed the foundation of both editions of this text. The ICF has been embraced by the American Physical Therapy Association and will be the framework for the 3rd edition of the Guide to Physical Therapist Practice (Guide; APTA, 2001), the second framework directing this text.
The new Child and Youth Version of the ICF (WHO, 2007) has been used in this new edition. Not only has the ICF now been accepted by physical therapists, but they have continued to embrace evidenced-based practice. The authors have been conscientious in reviewing and providing evidence appropriate to the content of each chapter. However, while there have been many new publications related to pediatric physical therapy, there is still a tremendous need for more research as so many questions remain unanswered. There is even conflict over interventions we think we have evidence to support. For example, we have systematic reviews to support the use of strengthening for children with cerebral palsy (Darrah, Fan, Chen, Nunweiler, & Watkins, 1997; Dodd, Taylor, & Damiano, 2002; Mockford & Caulton, 2008), but then a reanalysis of the literature suggested that “strengthening interventions are neither effective nor worthwhile” (Scianni, Butler, Ada, & Teixeira-Salmela, 2009). That was followed by another systematic review suggesting insufficient evidence to support or refute the efficacy of increasing strength in children with cerebral palsy (Verschuren et al., 2011). Those kinds of discord in the literature can leave a clinician questioning the evidence and which interventions to use. That is why in the model of evidenced-based practice there is a place for good clinical judgment.
While our colleagues work to answer the research questions and clinicians review the literature that is available and use their clinical expertise, I want to remind you of an intervention with tremendous face validity and a growing body of evidence: practice, practice, practice, as discussed by Drs. Valvano and LaForme Fiss in Chapter 8. Learning a motor skill requires practice. You did not learn to successfully play a musical instrument, ski, or play computer games without extensive practice. Olympic and professional athletes constantly practice their motor skills, as should a child having trouble with motor skill acquisition. Adolph and Berger (2006) note that early walkers walk the equivalent of 29 football fields a day! Does the average child with a disability learning to walk have the opportunity to walk 29 football fields even in a week? The acceptance of a family-centered model of service delivery in the natural environment will hopefully increase the opportunity for practice and motor skill acquisition in the children we serve.
Section 1 of this text continues to provide a foundation for physical therapy service delivery for children with disabilities and special health-care needs. Chapter 1, Serving the Needs of Children and Their Families, provides a background on pediatric physical therapy, the IFC, the Guide's management plan, models of team interaction, and factors influencing pediatric practice. This is followed by an entirely new chapter on child development, which was added to meet the requests of faculty who wish to have a review of typical development before they address developmental variations seen in the children we serve. Numerous books have been written on child development, so this chapter is but a brief review of development with a focus on motor skill acquisition. Of course, reading about development does not compare to observing development, and readers are encouraged to go out to playgrounds, preschools, and schools to observe the motor skills and interactions of children at a variety of ages. The best environment would be where there are children with disabilities included with children who are typically developing. That allows for comparisons of development and will expose the observer to the benefits of full participation of those with disabilities in the community. These experiences will bring to life the written discussion of the development. There is also a completely new Chapter 3, Child Appraisal: Examination and Evaluation. This includes a review of factors and philosophies influencing examination, tests and measures used in pediatric physical therapy, psychometrics, and documentation. The section ends with a chapter on family-centered care. This is a critical area of practice and is intentionally placed early in the text to provide an understanding of family-centered care as it is discussed throughout the text.
The second and largest section of the text includes major chapters on the musculoskeletal, neuromuscular, cardiovascular and pulmonary, and integumentary systems consistent with the framework of the Guide. For each system, the theoretical foundation and a framework are presented in a review of structures, functions, examination, evaluation, prognosis, diagnosis, and plan of care, which includes a detailed presentation of evidenced-based interventions. Unfortunately, as noted by Dr. Valvano in the first edition and still evident today, “most research on the effectiveness of intervention techniques is limited, sometimes equivocal and sometimes based on studies with small numbers of children … [E]ach therapist is encouraged to problem solve for each child, monitor motor function to determine effectiveness … and keep current with research findings.” A text can summarize only the research evidence to date; it is the professional obligation of therapists to keep abreast of the most recent literature.
Service delivery settings are presented in Section 3. Practice today is very much influenced by the setting. Federal and state laws govern service delivery in early intervention and school-based settings, insurance companies and reimbursement issues govern outpatient services, and the financial limitations of prospective payment impact hospital and rehabilitation services. The infants, toddlers, children, and adolescents seen in each of these environments also differ. Therapists must understand the unique elements of working in each of these settings and how they can provide quality services. These are brief chapters meant to expose the reader to the setting rather than provide extensive information. Originally, there was to be just one chapter on all of the service delivery settings, but that was too limiting, so having relatively concise chapters on each setting was the compromise. Foundational information on assistive technology and the supports available to aid all individuals with disabilities is included in Chapters 17 and 18. Therapists must be knowledgeable in the selection, utilization, and modification of these ever-changing technologies.
The final section of this text is a series of comprehensive case studies. These case studies highlight the multisystem involvement of many common pediatric diagnoses and changes over time. The case studies follow the model of the Guide and provide an overall perspective of the role of the therapist in examination, evaluation, diagnosis, prognosis, and intervention throughout the life of the child with a specific medical diagnosis in a variety of service delivery settings. The interventions and life events of each of the children presented in the cases has been updated in this edition to reflect their present status. Since several of these cases cover more than 20 years, the examinations and interventions done at the time the child was seen are outlined. In addition, we have included sections on current practice, which highlights what would be done based on best practice today for examination and intervention. Two new case studies have been added, one involving developmental coordination disorder and one on myelodysplasia.
Ancillary materials are available for both the readers and physical therapy instructors. There are videotapes of children with disabilities being evaluated and receiving intervention. The instructors' materials include additional case studies and a bank of test questions. Also provided is a test construction system that many faculty find very useful in developing and formatting their tests.
As noted in the first edition, Meeting the Physical Therapy Needs of Children in the 21st century will involve a continuous process of change and refinement. Therapists must discard deficit models of evaluation and focus on the goals and objectives of the child and family in a culturally sensitive manner. Intervention must be based on evidence supporting its effectiveness or, at the very least, based on sound clinical judgment and experience. Interventions must be discarded if there is no evidence to support continued use. The Guide's emphasis on coordination, communication, and documentation as part of the intervention process must be embraced. Services must be coordinated and communicated, and there must be carryover and practice throughout the child's daily routines. These processes assist in making certain that the child receives “appropriate, comprehensive, efficient, and effective quality of care” (APTA, 2001, p. 47/S39) from initial examination to graduation from services.