Complementary and Alternative Medicine in Rehabilitation.

Leskowitz E, ed. St Louis, MO 63146, Churchill Livingstone Inc, 2003, paperback, 496 pp, illus, ISBN: 0-443-06599-3, $44.95.

Complementary and Alternative Medicine in Rehabilitation brings together many prominent and dedicated advocates of complementary and alternative therapeutic approaches in rehabilitation medicine. These authors describe various therapeutic techniques, detail the direction of research, and outline their vision of the future of this rapidly growing field.

In the preface, the editor states that his interest in complementary and alternative medicine stems from his work as a psychiatrist in a pain management program where he saw how numerous complementary and alternative medicine modalities and philosophies can affect chronic pain. Based on his clinical experience, he organized a course called "Complementary and Alternative Medicine in Rehabilitation" for the Harvard Medical School. The intent of this text was to expand this course offering. The editor then says that rehabilitation is a team effort and that any text of this nature must be addressed to all members of the team. With this goal in mind, he assembled his team of contributors from all major clinical rehabilitation disciplines. He has attempted to show that a holistic approach to health care not only can be enjoyable to read about but also enjoyable to practice and to experience.

This text is divided into 5 main sections. The first section is devoted to representative therapeutic techniques from each of the 4 main dimensions of human nature (body/mind/spirit/energy). These therapies deal with what are considered by some to be the "body-oriented" treatments (eg, chiropractic and tai chi, the mind/body therapies (eg, biofeedback and meditation), the "energy-based" therapies (eg, acupuncture and electromagnets), and the emergent approaches (eg, spirituality and holistic nursing). Each therapeutic technique is defined, and a scientific foundation is provided. Case studies highlight the use of each technique in addressing patient problems, such as vertigo (in an Olympic diver), low back pain from muscle imbalance and disk compression, chronic imbalance pain, traumatic brain injury, kidney stones, amputation, and multiple sclerosis. Each chapter is well supported with references to peer-reviewed literature and, in some instances, to additional suggested readings.

The second section deals with specific conditions, such as cancel, Alzheimer disease, and chronic pain. The emphasis of this section is on clinical practice, with some chapters having a solid research base to build on, whereas others are more anecdotal in nature. As in the previous section, case studies demonstrate the use of complementary and alternative medicine approaches in addressing patient needs, such as coronary artery disease, alcoholism, post-stroke depression, and myofascial pain disorder. Several chapters provide resources for centers or consultants dealing with a specific condition.

The third section focuses on research directions in rehabilitation. Cutting-edge researchers in complementary and alternative medicine outline where their current research is headed, such as Samuel Shiflett's work on Reiki and stroke, Agatha Colbert's work on magnets and fibromyalgia, and Eric Leskowitz's work on therapeutic touch and phantom limb pain. Results and outcomes of selected studies published in peer-reviewed journals are presented in abstract format. These abstracted studies include some reports of negative outcomes, such as a report by Shiflett et al (eventually published as "Effect of Reiki treatments on functional recovery in patients in poststroke rehabilitation: a pilot study." J Altern Complement Med. 2002;8:755-763) and a report by Collacott et al ("Bipolar permanent magnets for the treatment of chronic low hack pain: a pilot study." JAMA. 2000; 283:1322-1325). Chapter 33 on laser acupuncture and carpal tunnel syndrome provides Web site and e-mail addresses for further information on research, photographs that demonstrate the application of therapy, and case histories and a list of videotapes of patients before and after treatment.

The fourth section of the text deals with the business aspects of complementary and alternative medicine in rehabilitation. Licensure and insurance issues, emerging business models of complementary and alternative medicine, future trends in complementary and alternative medicine, and publication of research in this area in medical journals are addressed. Liability issues arising from patient referrals to complementary and alternative medicine practitioners (ie, good evidence to support the practice and liability insurance held by practitioners), credentialing of providers (ie, descriptions of models and standards for credentialed programs), and quality assurance models are addressed. A brief summary of the scope of practice and regulation and sources of additional information for specific therapeutic practices are provided.

The fifth and final section presents the patient's perspective with 3 in-depth accounts of the rehabilitation process. The 3 accounts include a manual laborer with a spinal cord injury, a freelance journalist whose equilibrium was compromised by a skeletal imbalance, and an academic psychologist turned writer who had had a stroke. Each patient brings a unique perspective to the challenge of rehabilitation and the use of complementary and alternative medicine.

The editor has successfully achieved his goal and has provided a text that is enjoyable to read, that focuses on a team effort, and that demonstrates that complementary and alternative medicine modalities do have a role in rehabilitation. Complementary and Alternative Medicine in Rehabilitation brings a new dimension to the field with its infusion of case studies and current research. The book is well written and well organized.

The editor set out to provide rational guidelines for health care professionals and students to develop current knowledge about complementary and alternative medicine in rehabilitation. This book has achieved Ibis goal, describing therapeutic medical systems currently labeled as "complementary" or "alternative," applying these systems to specific medical conditions, and integrating these practices into mainstream medical practice. This text is recommended as a clinical reference for physical therapists, physicians, nurses, and practitioners of complementary and alternative medicine. Students could also benefit from this text as a reference for exploring the use of complementary and alternative medicine in rehabilitation.

Elaine L Bukowski, PT

Richard Stockton College of New Jersey 

Pomona, NJ

Ms Bukowski is Professor of Physical Therapy. She teaches anatomy, kinesiology, and orthopedics in the MPT Program. She is also a faculty member of the holistic health minor at her college. She has studied Reiki and has been certified as a Reiki Master. She has incorporated complementary and alternative therapeutic techniques in her clinical practice.