Cerebral Palsy: Science and Clinical Practice

B. Dan, M. Mayston, N. Paneth, L. Rosenbloom eds. Cerebral Palsy: Science and Clinical Practice. (Clinics in Developmental Medicine) London, UK: Mac Keith Press; 2014 (692 pages). ISBN 978–1-909962–38–5. EUR 245.00

According to the foreword by Prof. Fiona Stanley, this book is the first comprehensive text dealing with cerebral palsy (CP). The dimensions of the volume are impressive: close to 700 pages, and the size of the book is larger than the usual books in the DMC series (Aicardi size). Four editors have made a concerted action to recruit 80 authors who present 38 chapters.

The book is structured into the following four sections: “Concepts, natural history, and global perspectives,” “Pathways to cerebral palsy” “Diagnosis and principles of intervention,” and “Optimizing activity and participation.” An appendix lists several classification systems and scales (Gross Motor Function; Manual Ability; Communication Function; Eating and Drinking Ability; Functional Mobility Scale; Dyskinesia Impairment Scale; and Speech Assessment Protocols).

The text begins by clarifying terminology: The definition of CP is that by Rosenbaum et al (2007)—emphasizing the many comorbidities and resulting in activity limitation. Classification follows the proposal of the SCPE (Surveillance of Cerebral Palsy in Europe). Remarkably and fortunately (for me), the term “Intellectual Disability” is now used instead of “Mental Retardation” and “Learning Disability.”

Section 1 deals (among others) with “Historical Perspective”: a chapter on “Cerebral palsy in adulthood” and another on “A global perspective.” The latter reminds us, appropriately, that fewer than 10% of births occur in high-income countries. CP is an invisible public health problem in most of the world. There are ongoing several exposures known to be preventable (as undernutrition, iodine deficiency, and bilirubin encephalopathy). I have missed an update on epidemiology/prevalence.

Section 2, covering almost 20% of the text, deals with “Pathways to Cerebral Palsy”; possibly this section is referred to in the subtitle by the word “science.” Chapters cover malformations, perinatal stoke, hypoxia-ischemia, bilirubin encephalopathy, endocrine pathways (= thyroid hormones), maternal–fetal infection, and other pathways. I assume my expectations for this section were too high—a good resume but hardly light into the black box. The editors are fair to emphasize in the introduction to this section: “Even after comprehensive consideration and investigation, we are still not at a stage when the cause of CP can be identified with confidence in many individual children.”

Section 3 deals with motor control, clinical presentation, neuroimaging, neurophysiology, orthopedic assessment, intervention planning, assistive technology, etc. These are solid, well grounded, and informative texts.

Section 4 (covering almost half of the book with 16 chapters) is devoted to “Optimizing activity and participation”; remember that activity limitation is part of the 2007 CP definition. Thus, the focus is of ways in which activity and participation can be improved; the accent is not on the impairments itself. This is “Practice”! I found the chapters on “Oromotor function,” “Hand function,” “Lower limb function,” “Feeding and nutrition,” “Behaviour and mental health,” and “Sexual development, sexual health, needs, and lived experiences” particularly informative and instructive. I realize well that space is limited even in large volumes and it is “impossible” to cover all aspects. The text is indeed very comprehensive, and all treatment options are recalled, but at times only in a few lines. The paragraphs on gastrostomy, intrathecal baclofen, high-tech communication devices, and robotics are very short. I was looking for more information on life expectancy and genetic factors.

Overall, the volume is a comprehensive resource and can be recommended to all professionals working in the field of CP.