This new offering from Mac Keith Press’ Clinics in Developmental Medicine series is a fascinating look at the current state of affairs in the treatment of cerebral palsy (CP). The genesis of the book was a conference held in Banff, Alberta, Canada in December 2019, which was attended by many of the world's experts in the field. These leaders and practitioners met to discuss the breadth of movement disorders, muscle physiology, orthopedics, outcome measures, etc. and to determine how present-day treatments are affecting patients under their care.
Individual chapters present the state of the art in the literature, the authors' interpretations of the literature, and personal opinions on aspects of their particular expertise. Each chapter also provides a 5-year plan: what questions needed to be asked and a roadmap for obtaining answers. This is a unique use of material generated by a symposium and should be applauded.
The technology discussed in the second chapter is interesting, but sometimes reads like an advertisement for a system that is not on the market yet. The question and answer format is certainly thought-provoking, but can become repetitive and ultimately detracts somewhat from the chapter.
Chapter 3 gives a plethora of information on outcome measures. It would have been nice to have an outline of which outcome measures should be used for each of the dimensions of the International Classification of Functioning, Disability and Health. Most of the questions were related to ambulatory patients and the outcomes of intervention.
The term ‘Babylonian Confusion’ should be defined in Chapter 4. I agree that there is much confusion in the field and it often feels like we are speaking different languages describing the same problem. Video links to examples of what the authors (and other professionals) would define as spasticity, dystonia, etc., with scales and various tests that assess these problems, may have been helpful adjuncts to this chapter.
There is an excellent chapter on treatment of spasticity and dystonia. I was surprised that there was no mention of the botulinum toxin type B and/or the other, newer toxins on the horizon, especially in the 5-year plan. It was equally surprising that intrathecal baclofen was not mentioned more often in the treatment of dystonia (vs the use of deep brain stimulation).
While there was some overlap in the two chapters on muscle physiology, there is excellent data with the potential for improvements in treatment of spasticity and contractures, utilizing basic science and potential translational research advances. Since this is a textbook, the personal opinions of the contributors are included in the text. But this subjectivity is tempered by the fact that all the authors felt further study was necessary in order to test their hypotheses.
I especially enjoyed the chapter on musculoskeletal tendon unit dysfunction. It is obvious that the authors have spent their entire careers thinking about and grappling with these problems. It is also instructive to know that while we are still relying on surgery to lengthen muscles, there might be new ways to treat these problems just around the corner.
I highly recommend Improving Quality of Life for Individuals with Cerebral Palsy through Treatment of Gait Impairment for all of us who care for children and adults with CP. As mentioned, there is a very good review of the literature but most importantly, the gaps in our knowledge are addressed—and could be filled in—by the 5-year plans offered. The editors and authors should be congratulated for taking this complex condition on in such a systematic manner and making it accessible for all.
Clinical Orthopedic Surgery, University of California, San Diego, CA, USA.