Clinical Procedures in Therapeutic Exercise, 2d ed.

Sullivan PE, Markos PD. Stamford, CT 06912, Appleton and Lange, 1995, spiral bound, 264 pp, illus, $32.95.

As introduced by the authors, the purpose of the book is to "instruct the reader, in a step-by-step manner, how to perform therapeutic exercise procedures." It is a companion to Clinical Decision Making in Therapeutic Exercise, reviewed in the February issue of Physical Therapy. The book is divided into four parts: "Patterns of Movement," "Procedures," "Treatment Equipment," and "Treatment Sequences." Although not explicitly stated or completely referenced, proprioceptive neuromuscular facilitation (PNF) principles, patterns, and techniques are the bases for the authors' therapeutic exercise approach.

An organizational framework, using the concepts of activity (posture and movement pattern), technique (type of contraction and sensory input), and parameter (frequency, intensity, and duration), provides a consistent format for the book. One hundred and forty-eight activities are described and represented with average-quality photographs. In addition to the (ATP) activity, technique, and parameter framework, some activity descriptions list the impairments that they may ameliorate, the purpose and goals of the treatment, and problems encountered with application.

In Part 1, the authors describe and define unilateral and bilateral, upper and lower, and D-1 and D-2 extremity patterns in standing. The same patterns are performed in supine position and are applied to rolling.

Part 2, entitled "Procedures," is divided into two chapters: mat procedures and extremity procedures. Mat procedures are organized by exercise progressions and described in terms of biomechanical and reflexive factors. These progressions are also described along a continuum of motor control (originally described by Rood and elaborated on by Knott) composed of the following stages: mobility, stability, controlled mobility, static dynamic, and skill. Extremity procedures are performed as table patterns in either supine or sitting positions. The section concludes with a well-written summary, study questions, and six case studies.

In Part 3, 18 activities using pulleys and resistive bands as adjuncts to therapeutic exercise procedures are explained. In Part 4, the authors describe intervention models that apply the ATP framework and the stages of motor control to patients with a variety of joint dysfunctions and primary neurologic diagnoses. The model is illustrated with a three-dimensional chart that lists the appropriate activities, parameters of capacity, and stages of motor control in specific cells.

The bibliography suggests that a breadth of references were used to inform the text. Of special interest are the 50 research projects performed under the authors' tutelage that are not referenced elsewhere.

The book is comprehensive, and the ATP framework serves as a good organizational structure. Features that strengthen the book and distinguish it from other therapeutic exercise texts are the inclusion of a purpose, treatment goals, and difficulties with application for each activity. The reader, however, may be easily overwhelmed by the number of activities. The clinician is occasionally photographed using less than optimal body mechanics and incorrect manual contacts.

This book would serve as a recommended text in a therapeutic exercise course and as a resource for practicing physical therapists. It is best used by a reader who would like to be guided in the application of PNF principles and techniques and who is willing to invest the time in understanding the authors' framework.

Judith Deutsch, PhD, PT University of Medicine and Dentistry of New Jersey-School of Health Related Professions Newark, NJ

Dr Deutsch is Assistant Professor and teaches therapeutic exercise, management of the adult with a primary neurologic diagnosis, and research method. She is also conducting research on different aspects of PNF.