Clinical Case Study Guide to Accompany Principles and Practice of Cardiopulmonary Physical Therapy, 3rd ed,

Frownfelter D, Dean E, eds. St Louis, MO 63146, Mosby-Year Book Inc, paperback, 242 pp, illus, $19,95.

The first two editions of Chest Physical Therapy and Pulmonary Rehabilitation were highly regarded for their clinical relevance, but they discussed only the pulmonary system as it related to other physiological systems. This third edition and the accompanying clinical case study guide interrelate both the pulmonary and cardiac systems in health and dysfunction and incorporate the influence these systems have on the functions of the neurosensory and musculoskeletal systems.

The flow of information in this textbook facilitates learning, beginning with normal and abnormal anatomical and physiological function of the cardiac and pulmonary systems as they relate to oxygen transport. Next, cardiopulmonary assessment is presented, including chapters devoted to patient history, clinical assessment, pulmonary function testing, arterial blood gases, chest radiography interpretation, electrocardiogram identification, special cardiopulmonary tests, multisystem laboratory tests, and critical care monitoring systems. Principles, practice, and efficacy of cardiopulmonary physical therapy interventions are discussed and detailed in the chapters on mobilization and exercise prescription, body positioning, airway clearance, maximization of ventilatory function, and patient education. The remainder of the text deals with adapting these principles and practice to acute and chronic cardiopulmonary conditions for patients ranging in age from neonate to geriatric and in settings ranging from the intensive care unit to the home. The final section discusses related topics such as positioning and moving patients, respiratory therapy, managing the patient with an artificial airway, and the basics of cardiopulmonary pharmacology.

Because these two systems are so interrelated and because dysfunction, assessment, and treatment are so intertwined, it is sometimes difficult to discuss these topics individually. The authors attempt to not confuse the reader, but at times this is impossible. For example, discussions of pathophysiology often include results of pulmonary function tests that have not been covered. Also, graded exercise testing, as an evaluation skill, is combined with exercise prescription, a treatment technique.

Much of the information presented here is not available in other physical therapy text books, yet is crucial to maximizing treatment effectiveness for any patient. For example, the physiological effects of body positioning on the cardiopulmonary system can be applied to mobilizing any patient. The chapters describing normal and abnormal chest development, how to facilitate coughing techniques, and how to facilitate ventilatory patterns include strategies that can pertain to the neurologically involved population at any level or age group.

Figures, tables, and illustrations enhance and highlight important concepts throughout the text. Key terms at the beginning and review questions at the end of each chapter assist the reader in gleaning pertinent information from that chapter. A glossary of terms is included for reference and clarity. Contributors include physical therapists, nurses, physicians, and respiratory therapists who provide information from a variety of perspectives. References at the end of each chapter identify current and well-known resources in the field of cardiopulmonary practice.

The Clinical Case Study Guide accompanies this book as a teaching tool. The first two chapters create a background for clinical decision making by reviewing normal and pathological oxygen transport. The rest of the book contains 23 case studies that deal with all aspects of cardiopulmonary physical therapy. The case studies progress from simple problems or conditions to more complex scenarios. Each case study begins with a brief explanation of the pathophysiology of the disease, including its effects on oxygen transport; background information about the case study; and the rationale behind each intervention, which is presented in an easy-to-read tabular format. Each textbook can stand alone; however, if the authors had cross-referenced the two texts, the reader might have been better able to maximize the use of each.

The purpose of cardiopulmonary physical therapy is to prevent, mitigate, or reverse the threat to oxygen transport. Cardiopulmonary physical therapy includes the prescription for and delivery of noninvasive interventions for patients with acute or chronic and primary or secondary cardiopulmonary dysfunction. Comprehensive management of this population requires diagnostic assessment, treatment implementation, follow-up and reevaluation, and patient education. These two books do an excellent job of bringing the undergraduate and practicing therapist with minimal background in cardiopulmonary physical therapy to a degree of comfort with this aspect of care. The books incorporate the sophisticated and highly technical techniques with the simple hands-on methods. Educators will find the information current, complete in terms of the subject matter, and a helpful reference for creating case study examples to facilitate discussion and clinical decision making. Portions of the case study guide could be used to prepare for the clinical specialist examination. Because these textbooks present a multisystem approach, therapists working with any patient can benefit from them.

Nancy B Schuster, PT
Community Health Services
Portland, Me

Ms. Schuster is Physical Therapy Supervisor at a home care agency and serves as an adjunct instructor to physical therapy students in the area of cardiopulmonary physical therapy.