Early Development of Postural Control

Physiotherapists: 'Unknowns' in the Resea rch WorId MADAM - In the Journal report of the Representatives' Conference a section concerned the lack of reco,gnition (ignorance?) of physiotherapists' research work (Physiotherapy, November 1990, page 713). My experience is that it is generally assumed, by doctors, that doctors and scientists do - and should do, many of them would say - the research, with therapists accepting their findings and putting them into practice. When a physiotherapist's work is published in a scientific or medical journal, the rules of that journal with regard to qualifications listed have to be followed. In many journals, one or two degrees may be given but not 'Society-type' qualifications. So the MSc or whatever will be printed, but not the MCSP. A correspondence address is usually given; but if the therapist's base is, for example, a medical research centre or a

university department, there may be nothing in the qualifications or the address to indicate that the writer is a physiotherapist. So unless that fact can legitimately and appropriately be introduced into the text, the reader will not know that the author is a therapist. This is one reason why it would be good if Physiotherapy were again to be covered by lndex Medicus, as that is the first - and sometimes the only - reference work to be consulted by doctors and medical students. It is also assumed internationally that anything worth while will be cited in lndex Medicus. One result of this is that papers of mine cited there have aroused far more interest world-wide than those published in journals not listed in that Index. In the universities where I have worked, all researchers tried to get their papers accepted by journals cited in lndex Medicus on account of the frequency with which it is consulted and in order that their own findings should be widely disseminated. ANN GABELL BA MCSP Worcester

Early Development of Postural Control MADAM - The brevity of our article (Pountney, Mulcahy, Green, Physiotherapy December 1990 pp 799-802) seems to have caused some confusion. The request for the article originated from a Congress lecture of ten minutes in 1989. Additional information was added to the article, exploring the implications of our work and its clinical usefulness in assessing and treating children with a motor handicap. In 36 normal infants and 37 children with cerebral palsy not one child achieved independent sitting until they had achieved at least level 4 lying ability in prone and supine - to us this would indicate a definite link. This does not mean all children of level 4 lying ability can sit independently. Our study indicated at level 6 lying ability all children were of at least level 3 sitting ability. Although our study was observational our subjective observations were confirmed by using the acrylic topped table as described to identify load-bearing and load shift throughout the developmental sequence. A causal relationship could be established only by a longer study. Clinically it seems logical that a child who cannot achieve anterior tilt of his pelvis and protraction of the shoulder girdle would not be able to achieve that initial forward propping posture of independent sitting. Similarly side propping in sitting and lateral cunterpoise cannot be achieved without the ability to lateral weight-shift. It is only when a child has perfected this ability that he can move his head and upper trunk in response to environmental stimuli without overbalancing. It is therefore valid to say that the early developmental sequence does not proceed cephalo-caudally as the skills learnt

physiotherapy, March 1991, vol 77, no 3

in the horizontal position of lying are generalised to the vertical posture. Clinical experience shows that a child's physical abilities in all positions are interrelated and it was for this reason that all infants were observed in our study in sitting and standing together with lying. Full data of the study are available and a video describing lying and sitting ability in the normal infant is available for hire or purchase. ELIZABETH GREEN MB ChB BA DCH CATEY MULCAHY BScOT DipCOT TERRY POUNTNEY MCSP Rehabilitation Engineering Unit Chailey Heritage

Mrs Berta Bobath MADAM - I would like to add my smal! tribute to Mrs Bobath who died in January (see Physiotherapy, February page 99). I took the course on cerebral palsy in 1963 and at the time her immense concern was that 'these spastics' should be recognised as children with potential for development and independence. One of her greatest achievements must surely be her influence in establishing what is now common practice in this country: the early referral of infants and children with movement difficulties. 'Mrs B' taught m e to look and question what I had seen; to take action and question what I had done.

NOREEN HARE MCSP Nottingham

The Efficacy of Ultrasound MADAM - May I through this column draw your readers' attention to a paper written by Gillian Silman and myself and published in the The Practitioner of October 8, 1987 'Trial of ultrasonic therapy for acute herpes zoster'. It was also abstracted in Physiotherapy, February 1988 page 90. In the article by Sheila S Kitchen and Cecily J Partridge 'A review of therapeutic ultrasound' (Physiotherapy, October 1990, pages 593-600), our paper was not cited in relation to the treatment of herpes zoster. The authors state on page 596: 'Garrett and Garrett (1982) found that long-term pain was significantly reduced in herpes zoster following insonation; Jones (1984) reproduced these results. In neither of these t w o cases were the results supported by experimental evidence. Both papers being descriptive . . .'. I fully acknowledge that much more work needs to be undertaken in this area. However I must point out that the paper published by Mrs Silman and myself reports the results of a trial of ultrasonic therapy for acute herpes zoster in which a controlled group of patients took part. I assume that for some reason the authors of your article overlooked this reference which I feel is a modest yet important addition to the literature on this subject. ROBERT J JONES MPhil BA GradDipPhys MCSP Eastbourne

Ultraviolet Usage MADAM - We are trying to contact people who are currently using ultraviolet light, including PUVA, to treat skin conditions and who would be interested in getting together with a small group of dermatologists to draw up guide lines for its use. Could anyone interested please contact me at the address below. CECILY PARTRIDGE PhD FCSP Director Centre for Physiotherapy Research King's College London Strand London WCZR 2LS

Costing Methods MADAM - As the Oxford Regional Steering Group on the Costing of Physiotherapy Services we are looking at methods of costing that are presently being proposed or developed. Any information that could be forwarded to us on this topic or on groups similarly involved would be much appreciated. JACK1 GRlFFlTH MCSP Physiotherapy Department Horton General Hospital Banbury Oxon OX16 9AL

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