Coping with impaired mobility.

This is one volume in the Coping With Aging Series of works directed at individuals who are aging and their families and caregivers. Some of the topics covered in the series include low vision, hearing loss, depression, sexual dysfunction, incontinence, medications, and death and dying. This particular book, Coping With Impaired Mobility, is concerned with helping aging adults remain as mobile and independent as possible. It is written by a geriatrician and a physical therapist with a geriatric specialist certification. As with the rest of the works in the series, it is intended as a supplement rather than a substitute for the advice and instruction of health care professionals.

The book is very well organized and clearly written in a style appropriate for the general public. Medical jargon is avoided, but appropriate medical terminology is used as needed. Chapters include information on balance and strength, balance exercise, strengthening exercises, posture, flexibility and stretching exercises, circulation and heart conditioning, dizziness and unsteadiness, arthritis, osteoporosis, common conditions and drugs affecting mobility, feet, footwear, assistive devices to enhance mobility, and falls and home safety. Each topic is covered in a manner that is appropriate to a general reference on mobility problems, and usually includes information on prevention and safety specific to each. Reference is occasionally made to other volumes in the Coping With Aging Series. Illustrations are plentiful and generally helpful, although it is noted that the figure's hip in the illustration for the standing abduction exercise is actually quite externally rotated. This is unfortunate because this is one of the errors that therapists so often have to correct.

Although the information presented is very informative and comprehensive, a few points are worth mentioning in the hope that they might be corrected in future editions. In a discussion of posture, it is stated that flattening disks causes an exaggeration of the normal curves "resulting in a rounded upper back and shoulders and a swayed lower back." This is correct for the thoracic spine but not for the lumbar spine. In fact, as disks flatten, the lumbar curve decreases, resulting in a flattened lumbar spine (as is correctly demonstrated in the accompanying illustration). In the same section, instructions for a standing posterior pelvic tilt to decrease lordosis describe "tightening the buttocks," whereas no intention is made of the abdominal musculature. Also, a reference is made to a shoulder that might "freeze" if activities such as reaching into high cupboards are not done irregularly. This is a confusing point because "frozen shoulder" is usually the lay term for adhesive capsulitis. Decreased range of motion is typically the result, rather than the cause, of this disability.

Although the text does admirably well in emphasizing safety, it would have benefited slightly from a specific caution against sleeping with heating pads in place, because this is such a common and dangerous mistake.

Though not in reference to safety, there were some other unfortunate omissions. Exercise instruction for osteoporosis, although excellent for the spine and lower extremities, did not include even a single reference to the upper extremities. The section on assistive devices was very well done and an excellent inclusion in a book of this type, except that it did not mention a piece of equipment that is often important for the safety of the elderly: the transfer tub bench. These and other very minor points do not detract significantly from the fact that the book would be an excellent reference for the aging adult who is interested in information on mobility problems.

Even though the book is not specifically targeted at physical therapists, the beginning clinician may benefit from the practical information presented, especially that on safety, feet and footwear, and drugs. It would make a nice addition to the libraries of both physical therapy and occupational therapy curriculums and physical therapy and occupational therapy practices for use by patients.

Ms Mincer is a home health physical therapist currently, specializing in geriatrics. She has a master's degree in orthopedics.