The third edition of Meeting the Physical Therapy Needs of Children includes a new co-editor, Alyssa LaForme Fiss, PT, PhD, Board-Certified Pediatric Clinical Specialist. She adds a fresh look at the content of the book with recent experiences teaching entry-level physical therapy students at different universities and working in a variety of pediatric clinical settings.
Our book continues its tradition of using the International Classification of Functioning, Disability, and Health (ICF; World Health Organization, 2001) as its conceptual model and a systems approach to understanding disability.
The authors have been conscientious in reviewing and providing evidence appropriate to the content of each chapter. There have been many new publications related to research in pediatric physical therapy, along with more systematic reviews, meta-analyses, and clinical practice guidelines. Of course, there is still a tremendous need for more research as so many questions remain unanswered.
While our colleagues work to answer the research questions and clinicians review the available literature and use their clinical expertise, we must remember that increased practice of a behavior is an intervention principle with tremendous face validity and a growing body of evidence. This principle is discussed in Chapter 8 and throughout this text. 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 colleagues (2012) note that early walkers walk the equivalent of 46 football fields a day! Does the average child with a disability learning to walk have the opportunity to walk 46 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 American Physical Therapy Association’s Guide to Physical Therapist Practice (2014) management plan, models of team interaction, and factors influencing pediatric practice. This is followed by a chapter on child development. 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 developmental skills 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. Chapter 3, Child Appraisal: Examination and Evaluation, 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 placed intentionally 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, activities, examination, evaluation, diagnosis, prognosis, 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 often govern outpatient services, and the financial limitations of prospective payment affect 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. Foundational information on assistive technology and the supports available to aid individuals with disabilities is the concluding chapter although, admittedly, not a service delivery setting. 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 have been updated in this edition to reflect their present status. Because several of these cases cover more than 25 years, the examinations and interventions done at the time the child was seen are outlined. In addition, we have included sections on current practice that highlight what would be done based on best practice today for examination and intervention. Two new case studies have been added involving children with autism spectrum disorder and congenital muscular torticollis. These are important diagnostic entities given that autism spectrum disorder is now the most common developmental disability, and congenital muscular torticollis was the first diagnosis to have a pediatric physical therapy clinical practice guideline (Kaplan, Coulter, & Fetters, 2013).
All of the chapters in the first two sections now include highlighted Key Points. Ancillary materials are available for both the readers and physical therapy instructors. There are video recordings of children with disabilities being evaluated and receiving intervention. The instructor materials include test bank questions, new classroom learning activities, and an image bank. There is also a list of web resources available to instructors and students.
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 should be provided 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, person-centered, and high-quality health care services throughout the continuum of care” (APTA, 2014).
Susan K. Effgen
Alyssa LaForme Fiss