Clinical Electrotherapy, 2d ed.

The intent of the second edition of this text is to update the first edition and to become a state-of-the-art text for both practitioners and students. In addition to retaining the previous chapters on the physiology of nerve and muscle function, instrumentation, principles of stimulation, and clinical uses, the authors have added content on the use of electrical stimulation for tissue healing, microcurrent electrical neuromuscular stimulation, and magnetic stimulation. The contributors are well-known and respected physical therapists who have studied electrical stimulation and used it extensively in patient management.

The book is generally accurate, well written, and extremely well referenced. The chapter on principles of electrical stimulation by Alon is especially noteworthy. The author makes a strong attempt to define terms in a consistent fashion and to emphasize the importance of analyzing the capabilities of a particular piece of equipment in light of the goal of use, rather than relate a stimulator to a particular purpose. He focuses the reader on research rather than on manufacturers' claims or unsubstantiated beliefs. The author offers a model of use, emphasizing critical thinking, and encourages the reader to select parameters of treatment based on the goal of treatment rather than on a "cookbook" approach. This chapter does offer treatment outlines, but they actually detract from the text's purpose, as they are not discussed specifically and could be misinterpreted as recipes for treatment.

As with the chapter on principles of electrical stimulation, the chapters on transcutaneous electrical nerve stimulation (TENS), iontophoresis, and biofeedback are especially well written, informative, and thoroughly referenced. The new chapter on magnetotherapy is interesting and enlightening. All chapters have been updated and are very current, with the exception of the chapter on high-voltage stimulation. Perhaps because of the amount of time needed to prepare a book for publication, there is no discussion of the prolonged treatment times needed for edema reduction and wound healing, a subject of considerable research in the last 2 years.

Not all chapters adhere to the approach developed in the chapter on principles of electrical stimulation. After making the case in the chpater on principles that polarity with high-voltage stimulation may make little difference in treatment, the chapter on high-voltage stimulation emphasizes the difference. After emphasizing research in the chpater on principles, the chapters on specific instrumentation suggest specific uses in the absence of research support. This is exemplified in the chapter on interference current, wherein the cloverleaf pattern of the resultant current is not examined in light of literature that supports greater density under the electrodes. The use of interference current as "acupuncture-like TENS" is encouraged, even though the parameters of treatment are different and the author offers no evidence that neuropeptides are produced.

The book begins generally and appropriately with chapters on physiology, instrumentation, and principles of stimulation. The fourth chapter deals with the effects of stimulation on healthy muscle and tissue repair. The author of chapter 4 addresses histological and metabolic effects of muscle stimulation and then turns to the use of electrical stimulation with scoliosis; urinary dysfunction; and healing of wounds, tendons, and ligaments. The next three chapters deal with denervated muscle; the use of stimulation for innervated muscle, including improving and maintaining range of motion, facilitation and reeducation, spasticity management, and orthotic substitution; and the use of stimulation to strengthen healthy muscle and to change blood flow. This last chapter, though accurate and thorough, repeats the inormation on metabolic effects of stimulating healthy muscle. The last several chapters are about specific instrumentation and cover the production of current from the instrument, as well as its clinical use for many of the same goals. Contraindications are not mentioned until chapter 8 in the beginning of the discussion of different machines and are repeated for each machine. Because contraindications of stimulation differ slightly depending on the machine used, they should be discussed along with the general principles and effects.

The use of treatment goals as an organizing scheme is appropriate. The way they are implemented in this book seems fragmented and requires some repetition of material. Perhaps a more efficient organization would have been to retain the overview of physiology, instrumentation, and general principles and to include the different instruments and their production of current with the material on instrumentation. Reference to different instruments could have been made in the discussion of clinical goals. The clinical goals section could have begun with the effects of stimulation on healthy muscle, followed by the material on strengthening healthy muscle. The other goals of stimulation with innervated muscle could have followed, including maintaining and improving range of motion, facilitation, tone management, orthotic substitution, scoliosis correction, and urinary retention. The discussion of denervated muscle could have concluded the section on motor stimulation, and separate chapters on tissue repair, blood flow, and pain could have concluded the section on clinical goals. This approach would have allowed the emphasis to be on identifying correct parameters for a goal and on determining whether there is a match between the required parameters and the capabilities of a particular machine.

The editors have accomplished their goal of producing a state-of-the-art text. In spite of its small flaws, the text is useful for practitioners and students. As with most texts designed to discuss theory and research of a treatment approach, faculty members will have to supplement this text with another text or with laboratory instructions on electrotherapeutic techniques.

Karen W Hayes, PhD, PT Northwestern University Chicago, Ill