Functional Rehabilitation in Orthopaedics.

Functional treatment and outcome assessments are not new concepts to the rehabilitation specialist, but they have not been widely used for the general orthopedic patient. Society, however, has taken a greater interest in functional outcomes as health care dollars have become more limited. This book, therefore, was written to increase the rehabilitation specialist's understanding of functional assessment and restoration.

The author introduces functional rehabilitation by illustrating (with a case study) some of the limitations of the treatment concepts used, and outcomes obtained, in current orthopedic rehabilitation approaches. She then operationally defines classification systems for impairments, disabilities, and handicaps, and different types of function (basic activities of daily living, instrumental activities of daily living, etc.)

Prior to discussing functional exercise progression and specific exercises for the upper and lower extremities, the author presents a variety of motor learning theories in an attempt to provide a scientific rationale for the use of functional rehabilitation. There are two chapters related to assessment, one on determining the causes of disability and the other on various functional assessment tools. Additional chapters are devoted to topics such as lumbar functional stabilization programs (contributed by Beverly Biondi, PT), geriatric functional rehabilitation, function exercise classes, fitness and functional exercise, and adaptive equipment. The lone appendix was included to provide a review of the gait cycle.

The author has done a nice job of describing various aspects of functional assessment and rehabilitation. The occasional insertion of cases studies is instructive. I was particularly impressed with the sample functional assessment tools provided. The narrative is supplemented with a good assortment of figures (both line drawings and photographs), tables, and exhibits. Although there is a paucity of research on functional exercise and outcome measures, the author provided some related references and additional readings with each chapter. The chapter on exercise equipment included descriptions of devices, environments in which the equipment might be most useful, listing of vendors, and in some cases, cost of the equipment. Descriptions of adaptive equipment were provided primarily for the physical therapy practitioner.

One drawback of this book is that a plethora of facts are thrown at the learner with only a semblance of organization and an oversimplistic explanation. For example, it would have been more logical to combine or sequence the topics of assessing disabilities and functional assessment tools, but these chapters were separated by 130 pages. It seemed that the author's choice of what to describe in some detail and what to leave out was arbitrary, and I did not get a good sense of coherence. Additionally, in an attempt to be concise, the author occasionally oversimplified matters to the point of inaccuracy and nonusefulness. For example, she makes the following statement: "Specific treatments to correct patella tracking include the use of ultrasound, . . ." I do not believe that ultrasound has been shown to improve patellar tracking. Although I understand that fitness was not a primary theme in this book, its chapter was lacking in substance. Finally, I did not find the appendix useful, primarily because the information came from a 1967 reference and is no longer being used by the original author.

Although I did not find anything particularly innovative or creative in this text, I think that some of the information could be useful for the inexperienced physical therapy and occupational therapy rehabilitation specialists and students.

Gordon J Alderink, PT Grand Valley State University Allendale, Mich

Mr Alderink is assistant professor in the physical therapy program, where he teaches courses on orthopedics, manual therapy, and biomechanics. He also directs a gait analysis laboratory and does research on gait dysfunction related to cerebral palsy.