Outcomes after selective dorsal rhizotomy

Abstract

that place their functional communication development at risk. I agree that the evidence provided is supportive of the need for early intervention services targeting factors (e.g. communication, an Activity/Participation component) that optimize school readiness and ultimately improve later educational outcomes. That being said, an observed caveat of this research is that maternal education, a wellknown environmental predictor of child outcomes, was not included as a variable of interest. Consequently, the argument that factors related to body functions and structures and not environment were predictive of functional communication at school entry must be tempered by the authors' own acknowledgment of this limitation in their research.There are important clinical implications associated with the findings of the Coleman et al. paper. First, the authors have provided empirical evidence that is needed to guide clinical practices (i.e. which children are at greater risk and how we might best support them). Second, the paper has clearly demonstrated that there is room for improvement in supporting functional communication in children with CP prior to school entry. Third, service providers, parents, and entities providing access to care are encouraged to support quality functional communication, which begins with early access to the services needed by children with CP. Last, the need for future research to understand the nature of relationships between other predictors and functional communication has been highlighted.