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Edited by Teresa E Pountney, Catherine M Mulchahy, Sandy M Clarke, Elizabeth M Green. Chailey Heritage Clinical Services, 2004, £30.00, pp 194. ISBN 0954825802
Disorders of posture are a frequent feature of neurological disability. These often limit a child’s ability to function efficiently and access his/her environment. They also tend to progress in time with a potential for further loss of abilities, orthopaedic complications (such as scoliosis and hip dislocation), and secondary pain. Therefore professionals who work with these children find themselves constantly battling to maintain and, if possible, correct these abnormal postures. I often find myself in the situation of having to recommend interventions or prescribe expensive and sometimes cumbersome postural equipment for which only little evidence of efficacy is to be found in the medical literature. I was therefore looking forward to reading The Chailey approach to postural management in which I hoped to find some answers to my predicaments.
This book presents the approach developed over 20 years of research and clinical practice at the Chailey Heritage Clinical Services, a centre that has acquired national recognition in the management of children with complex physical disabilities. It progressively brings the reader to understand the principles of posture analysis and how to solve postural problems. The pedagogic style is very much that of a training manual, with multiple questions and activities targeted at the reader, and it was no surprise to learn that Active Design Ltd (the company who manufacture the postural equipment described in this book) run courses using this volume as their reference material. The theoretical basis that underpins the approach is concisely but clearly described in a series of chapters on the relevant aspects of biomechanics, neuroplasticity, motor control, and motor learning theories. The book is well referenced and the text is supported by a number of excellent illustrations.
The management programme per se relies mainly on the 24 hour provision of postural equipment for lying, sitting, and standing. This may seem quite a heavy handed approach and one could question its tolerability in certain children. However its efficacy in reducing hip dislocation is already partly supported by a retrospective study, and further research is underway in a 5½ year longitudinal prospective study at Chailey Heritage Clinical Services. I certainly look forward to reading their conclusions, and I hope they will feature in the book’s next edition as additional support to the approach.
Overall, working in the field of paediatric rehabilitation I found The Chailey approach to postural management a useful read and it did provide me with a better insight into the evaluation of postural disorders and their treatment. It gave me elements which will hopefully allow me to deal with these issues more confidently in the future. The great strength of this book is that it offers a clear and coherent approach to what is a common problem in neurodisability. As such I would recommend it as an essential reference in all multidisciplinary centres that care for children with neurological impairments.
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