Tuesday, 5 October 2010

Useful knowledge

At a price

The journal Orthopedic Clinics of North America is currently running a special edition called 'Orthopedic management of cerebral palsy':

If you are immersed in the care and upbringing of children and adults with cerebral palsies, you might like to read the short introductory review to this issue, written by Henry Chambers, parent/carer and leading surgeon, available in full on line:

Three general background articles

Rethlefsen, S. A., Ryan, D. D., Kay, R. M. (2010) Classification systems in cerebral palsy, Orthopedic Clinics of North America, vol. 41, no 4, pp. 457-67
Because of increasing interest in conducting large-scale, multi-center investigations into the epidemiology of cerebral palsy and its prevention and treatment, efforts have been made to establish a standard definition and classification systems for cerebral palsy. In recent years there has also been increased focus on measurement of functional status of patients and new classifications for gross and fine motor function have been developed. The purpose of this article is to update the orthopaedic community on the current classification systems for patients with cerebral palsy. This information will be of value to surgeons in determining patients' suitability for certain treatments and will also assist them in reviewing current literature in cerebral palsy.

Blair E. (2010) Epidemiology of the cerebral palsies, Orthopedic Clinics of North America, vol. 41, no 4, pp. 441-455
Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention.

Murphy, K. P. (2010) The adult with cerebral palsy, Orthopedic Clinics of North America, vol. 41, no 4, pp. 595-605
Advances in medical and surgical care over the past 20 years have resulted in children who formerly would have died at birth or infancy now surviving well into adulthood, many with permanent physical disabilities, including those caused by cerebral palsy. Inadequate medical and surgical diagnoses and intervention are prevalent in the adult cerebral palsy population. Decreased physical activity and participation in physical therapy and fitness programs, along with loss of strength, contractures, and pain are common factors in the loss of functional weight bearing, self-care, and daily performance over time. Increased awareness of these problems is needed by adult health care providers who provide care to these individuals and also by pediatric providers who may be able to intervene and prevent some of the long-term problems. Early identification and intervention in the child and younger adult remain the ideal in the pursuit of optimal musculoskeletal function and lifestyle throughout the adult years.

Surgical snips

Never mind potentially alienating faux-technical jargon like ' functional status of patients' (what people can do?), 'management of persons' (caring for people?) – look beneath to see what reality is reported. These three articles look like they might prove useful updates on the general situation, for people concerned with individuals or smallish populations within the whole.

These, however, are not open access – but a snip at US$ 31.50 each!

A problem seeking a solution

Hospital departments, university libraries and highly paid health professionals like surgeons can of course afford to subscribe to journals. Conductors and co-workers in small, cash-strapped centers, and parents who wish to comb the 'literature' to help construct their own personal judgements, are far less favourably placed.

The conductive sector is thereby spared exposure to an awful lot of journal-tosh but, where materials are potentially useful, then the sector loses out and drifts ever further away from learning from and contributing to society's wider conversations. What could or should be done about this?


Read a little more about Henry Chambers and the specialist centre that he directs in San Diego, California. What a catch he would have been for Conductive Education:

And read of his glancing brush with CE a few years back (you will find him at the bottom of the page):

The 'treatment outcome review' by Johanna Darrah and her colleagues that he co-signed off, its 'appropriately cautious' conclusions notwithstanding, looks in retrospect to have sounded CE's death-knell amongst paediatricians in the United States (and not just in the United States).

Again: what a waste.


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  2. I searched in vain through all your links, Andrew, for an answer to the one question that troubles me: what should happen when a child with cerebral palsy goes to school? Indeed, I searched in vain for any hint from these so-well educated, respected and remunerated people that this was even a valid question.

    I have been searching for 28 years.

    I don't even dare to ask about the learning development of a pre-school child with cerebral palsy.

    Someone might say, but these are medical people, Norman. Ask the educators about learning and education. Problem is, the educators rely on the medical people - and say little for themselves.

    Reader, there's a simple test. Search for "cerebral palsy" and "education" (taking care to exclude "conductive education") and see what you get. If you get anything worth reading, do share it with us.