Joint Mobilization: Techniques for Managing Restricted Range of Motion.

Harrelson G, Leaver-Dunn D. Thorofare, NJ 08086, Slack Inc, 2002, CD-ROM, ISBN: 1-554642-442-6, $189. [System requirements: For PC: Pentium-based PC or above, Microsoft Windows '95 or later, 6X CD-ROM drive, 32 MB of RAM, 10 MB of hard disk storage, 1 MB or higher SVGA video card, 8-bit Sound Blaster-compatible sound card, QuickTime 5.0 or higher (included). Macintosh: Power PC or above, 32 MB of RAM, 10 MB of hard disk storage, Mac OS Version 8.6 or later, QuickTime 5.0 or higher (included).]

The primary purpose of this software program is to provide an introduction to the theory and practice of joint mobilization. It can be used as a learning tool for the beginning clinician and as a reference tool for the practicing clinician. However, it is not meant to be the sole source of educational material.

This program was evaluated on a Dell Inspiron 8000 laptop with Windows Millennium Edition. The color setting had to be adjusted from the 256 Colors setting to the True Color (32 bit) setting to allow the program to install and run. As recommended by the installation instructions, the screen saver was disabled during use.

On the opening page of the program, the viewer has the option of entering a reviewers' page that provides a list of the health care professionals who reviewed this CD-ROM, which includes athletic trainers, physical therapists, and occupational therapists. The viewer can also enter a resources page with a list of books and journals on joint mobilization and biomechanics published between 1990 and 2001.

The main program is divided into 3 major areas: "Principles," "Body Regions," and "Quiz." Each area has a video clip accompanied by audio and written script. The viewing area is set up so that the video clip and the written script can be viewed simultaneously. The video clip can be rerun as the viewer's needs dictate. One distracting feature of the video clip, however, was the static picture (of the side-lying subject with the clinician's hands placed on the subject's pelvis) that was used during some audio explanations. This picture did not correspond to the explanation. It would have been better to use an animated drawing, similar to the drawings used in the "Principles" section of the program.

Initially, the "Principles" component provides a general overview of joint mobilization and the definition and uses of joint mobilization. From here, the viewer can then enter several subdivisions, such as "Joint Kinematics," "Physiological Effects," "Joint Assessment," "Convex-Concave Principle," "Indications and Contraindications," and "Application."

Each subdivision starts with lesson objectives, proceeds to the main content, and concludes with a lesson summary. Many good and practical examples, which help the viewer readily apply the principle to the human body, are given throughout this section of the program. Practice questions are offered at the end of each subdivision topic. These practice questions provide the viewer with immediate feedback as well as a score tally. The viewer has the ability to reset the questions and retake the quiz or move to another section of the package.

The "Body Regions" section covers the foot, ankle, knee, hip and pelvis, sacroiliac joint, spine, shoulder, elbow, and wrist and hand. The main traction and glide techniques are presented for each body region. The written script contains the indications for using a particular technique, the patient's position, the clinician's position, location of the stabilizing hand and the mobilizing hand, and the direction of force application. In addition to being able to replay the video clip, the viewer can focus on the body positioning, the hand positioning, or the force application by clicking on the appropriate topic.

At the top of each screen, the viewer can click on a Skill Sheets button. A message pops up notifying the viewer that a skill sheet is available at the publisher's Web site. One purpose of the skill sheet is self-testing, but other uses include classroom or laboratory evaluations in the academic setting and assessments in the clinic. Each skill sheet contains the technical points for performing the particular technique as well as a photograph of the hand placements, with an arrow indicating the direction of the force application. Notes on how to score the test are provided.

There are a total of 55 techniques demonstrated in this section. Some useful joint mobilizations, such as the carpal-on-carpal glides and metacarpophalangeal distractions, are not demonstrated or mentioned in the program. This is also true for some mobilizations used with the temporomandibular joint. This section also lacks a set of practice questions for each body region, which would have been a definite plus in reviewing each body region.

The viewer should keep in mind that some techniques demonstrated in this program may be known by other names, depending on the school or system in which the viewer was taught. For example, the inferior femoral glide in 0 degrees is also known as a long axis distraction of the femur. These alternate names are not used in the program.

In the application component of the "Principles" section, bony overlays are used during the demonstration of a technique to help the viewer visualize what the bony segments are doing during a specific joint mobilization. This type of bony overlay would have been beneficial in the "Body Regions" section to help viewers visualize the underlying structures that are being stabilized and mobilized.

The last section of the program is the self-quiz component, which consists of a randomized set of multiple choice questions (4 possible answers) on all aspects of joint mobilization covered in the "Principles" and "Body Regions" sections. Immediate feedback with the correct answer is provided, along with the rationale for the correct answer. A score tally is also available. The viewer can take the quiz numerous times without getting the same order of questions twice in a row.

This program is intended for beginning allied health and medical professionals and students in advanced phases of an education program who have an understanding of anatomy and physiology and have preparation in orthopedic assessment. For the student, this program could be used as a supplementary study aid for learning joint mobilization and as a review aid for preparing for written and lab examinations. For physical therapists and other health care professionals, this program could provide a valuable review or refresher of a particular technique if the clinician has not used a particular technique for some time.

Elaine L Bukowski, PT, MS
Richard Stockton College of New Jersey
Pomona, NJ

Ms Bukowski is Associate Professor of Physical Therapy in the MPT Program, where she teaches classes on human gross anatomy, kinesiology and basic physical therapy examination techniques, and musculoskeletal physical therapy. Her current research interests include the use of technology-enhanced learning and clinical studies on the use of complementary and alternative medicine.