Balance Disorders: A Case Study Approach.

Furman JM, Cass SP. Philadelphia, PA 19103, FA Davis Ca, 1996, hardback, 341 pp, illus, $74.

As the title suggests, this book presents basic science of balance disorders with increasingly complex case studies. Written for medical students and residents during their neurology and otolaryngology clinics, topics are presented in an interesting, problem-based format. The authors suggest that any physician who encounters a patient complaining of dizziness may benefit from reading the cases and implementing appropriate treatments.

The book begins with a preliminary background for the case studies that follow. Background information includes chapters on vestibular anatomy and physiology, auditory and vestibular laboratory tests, and a short chapter on vestibular rehabilitation. Although the chapters are not intended to replace specific textbooks on each topic, the information presented is well illustrated and provides a reasonable overview of the complex vestibular system. Platform posturography, often performed by physical therapists, is included as a vestibular laboratory test.

The chapter on vestibular rehabilitation is brief but presents physical therapy as a vital component of treatment. Theoretical bases for rehabilitation, appropriate patients for physical therapy, rehabilitation goals, and expected outcomes are covered. Specific assessment techniques that a therapist may use are outlined with sample interventions. The chapter is well referenced and presents vestibular rehabilitation programs in a positive and realistic manner

The bulk of the book consists of three sections of case studies. The first section, "Tutorial Case Studies," which refers frequently to the background chapters, relates clinical signs of peripheral, central, or mixed vestibular disorders to vestibular anatomy and function. Common laboratory test results are presented with interpretation and medical interventions.

The section entitled "Common Disease Case Studies" contains the greatest number of cases (26). Many diagnoses are presented, including vascular compromise, bilateral vestibular loss, cervical vertigo, endolymphatic hydrops, benign paroxysmal vertigo, nystagmus, perilymph fistula, and otosclerosis. Common disorders are discussed in multiple cases, whereas specific issues are addressed in each case.

The final section, "Unusual Disease Case Studies," alerts the reader to rarer causes of dizziness. The authors suggest that the experienced physician refer to the cases as they occur in practice or as they pertain to personal interest. Samples of topics covered include vestibular dysfunctions caused by midbrain disorders, saccadic movement dyscoordination, vascular problems, coma, epilepsy, and inner-ear malformations.

Information presented seems to be correct and current. The authors warn that specific pharmacological or surgical interventions may change over time. Each chapter and case study contains a reference section. An "Appendix of Diagnoses" and an index simplify finding information directly. All cases are extensively cross-referenced to relevant material throughout the text.

Overall, the book is well written and well organized. Material is presented in an interesting and informative manner with ample illustrations and examples. The chapters on basic science of the vestibular system would be quite helpful to physical therapy students or clinicians specializing in vestibular dysfunction or balance disorders. However, this reader agrees with the authors that the text should be supplemented with specific texts on vestibular anatomy, physiology, and rehabilitation.

Sondra E Dunkle, EdD, PT
Idaho State University
Pocatello, Idaho

Dr Dunkle is Professor in the Department of Physical Therapy and specializes in neurological rehabilitation, aging, and balance disorders.