Electrotherapy in Rehabilitation.

Overall, Electrotherapy in Rehabilitation is very similar to other electrotherapy texts. The main difference between this and previous texts is this book's emphasis on clinical practice rather than on extensive reviews of the literature. Each chapter is written with a clinical orientation and has either a section on clinical problem solving or a case example. There are two particularly valuable chapters on clinical problem solving with the use of electrotherapy in the patient with an orthopedic or neurological condition. Each of these two chapters develops a systematic approach to the use of electrotherapy using several clinical case studies. The problem-solving approach used in these chapters covers the use of electrotherapy from the initial evaluation through the development of a home program. These chapters emphasize goal setting and the evaluation of clinical outcomes. The weakness of these problem-solving chapters is the lack of integration of electrotherapeutic procedures with the other treatment approaches that would be used in each case. This lack of integration places an inappropriate emphasis for the student on the use of electrotherapy in an overall treatment plan.

The chapter on transcutaneous electrical nerve stimulation (TENS) exemplifies this emphasis on the clinical aspects of electrotherapy. This chapter uses 16 pages to cover the various clinical conditions that can be treated with TENS. Although a wide range of conditions are addressed, the coverage of many conditions lacks depth. For instance only two studies are used to document the treatment of headache. The TENS chapter addresses the evaluation of pain, TENS application, and recommendations for home programs. It also includes a case study to further illustrate the application of TENS.

In addition to the problem-solving chapters and chapter sections, the emphasis placed on the electrical evaluation of nerve and muscle and on electromyographic biofeedback (EMGBF) provides a very valuable feature to this book. The chapter on EMGBF is an excellent introduction to this subject. The EMGBF chapter outlines the basic principles of EMGBF and then applies those principles to different patient populations and types of disorders.

There are problems with the book, however. There are inconsistencies in terminology. In her specific chapter, the editor praises the terminology standards developed by the Clinical Electrophysiology Section of the American Physical Therapy Association (APTA), but then she allows such things as the use of the term "faradic stimulation"; the classification of TENS as "high-rate conventional," "low-rate acupuncture-like," and "brief intense," rather than subsensory, sensory, motor, and noxious; and the use of the term "medium frequency stimulation" for burst modulated alternating current.

The separation of the chapter on TENS from other forms of electroanalgesia is very artificial, given that the protocols, electrode placements, and stimulator settings are similar regardless of the stimulator or current type. These could be easily and perhaps more logically combined into a single chapter. An example of this artificial separation is that the section on microcurrent therapy (MENS) appeared in the TENS chapter and not in the chapter on electrotherapeutic alternatives. Because of increasing use of MENS, the MENS section should have been expanded to include details about the waveform, current levels, electrode setups, treatment times, and other procedural details. Because there is little support for the efficacy of MENS treatment, the repeated criticism of its use should continue to be emphasized. Despite these criticisms, there was a highlight in the chapter on electrotherapeutic alternatives This chapter contained the best description of diadynamic stimulation I have ever seen. Although diadynamic stimulation is not commonly used in the United States, many references to it are seen in the European and Canadian electrotherapy literature.

The chapter on the principles of nociception is very weak in my opinion. It is written at a basic, descriptive level and addresses various theories of pain and other aspects of nociception without a critical examination of these theories or other points. Except for briefly mentioning electroanalgesia at the end of the chapter, no attempt is made to indicate the significance of electrotherapy or electrotherapeutic principles. No attempts are made to address the evaluation of pain or other forms of pain management. Very little emphasis is placed on recent research. All of the references from the 1980s are review articles, and no article is more recent than 1988.

In the chapter on neuromuscular electrical stimulation, too much emphasis is placed on biphasic pulsed stimulators. Only one of nine illustrations showed any stimulator other than the Medtronic Respond II [TM]. There is little coverage of the burst modulated alternating current stimulators, and there is no mention of monophasic pulsed stimulators. Even the electrodes addressed and illustrated are those used on the portable, biphasic pulsed stimulators, such as the Medtronic Respond II [TM]. The terminology in this chapter does not correspond to the standards developed by the Clinical Electrophysiology Section of the APTA. A particularly good feature of this chapter is the section on the application of neuromuscular electrical stimulation to the pediatric patient.

The last criticism is a relatively minor one. Although it is interesting that the founder of Methodism, John Wesley, wrote a book on electrotherapy, in my opinion there is no need for sections on the history of electrotherapy. Teachers rarely assign these sections, and students rarely read them. They are best deleted from electrotherapy texts.

Electrotherapy in Rehabilitation is written for the physical therapy student and the physical therapist who is interested in a general discussion on electrotherapy. There are few differences between this book and others available. The one feature that would make a student or therapist buy this book instead of another would be the emphasis on the use of electrotherapy in clinical practice.