Key Issues in Neurological Physiotherapy.

Key issues in Neurological Physiotherapy 

Ada L, Canning C, eds. Stoneham, MA 02180, Butterworth-Heinemann, 1990, paperback, 290 pp, illus, $59.95.

Janet Carr and Roberta Shepherd have initiated a new series of books, entitled Physiotherapy: Foundations for Practice, with this volume. The stated intent of the series is to provide information for the entry-level student that will serve to introduce the concepts of deduction of clinical implications from a combination of theory, and data collection and analysis. This first volume addresses problems in analyzing and treating adult patients with neurological involvement.

There are two parts to the current volume. Part 1 addresses several aspects of the motor learning model of neurological problem management. Five chapters discuss the motor learning model itself, disorders of motor control, measurement of human motor performance, attention control and behavior management, and the patient as an active learner. The second part of the text primarily addresses problems related to cardiorespiratory function and soft tissue condition in persons with neurological disorders.

As a whole, the text is smoothly written and very well organized. There are extensive, clear illustrations and photographs. Each chapter's author has provided thorough reference lists that are both current to the date of publication and historical in coverage.

The chapters that cover specific clinical measurement and management techniques have the distinct advantage of being highly specific and detailed. The student or therapist would need little, if any, additional information to put the ideas in these chapters into practice in the clinical setting.

Although this volume is very well written, there are some definite problems with the potential use of the book as a text for an entry-level course in neurological problem management. The editors clearly state that it was not their intent to duplicate existing material relevant to neuroscience or neuropathology. The absence of this information, other than in the chapter by Gordon, "Disorders of Motor Control," would require the additional use of texts to cover this material. Given the cost of this text, the addition of other texts might well be viewed with disfavor by faculty and students alike. Another problem is the presentation of one predominant approach to management of neurological problems, specifically, motor learning. Although this is currently a very popular approach to management, it is certainly not the only one in use. The techniques indicated may be ideal for some patients, but other patients may require other approaches or might recover equally as well in other settings. In particular, some patients can be expected to respond negatively, or with minimal compliance, to the highly structured and almost patronizing approaches suggested for behavior management. Again, the lack of addressing other alternative approaches would necessitate the addition of another text for student referral. Finally, the lack of discussion of pediatric management, although again intentional, limits the applicability of this book as an entry-level text.

I would recommend use of Ada and Canning's book as a resource rather than a required text for entry-level students and as a reference for clinicians or more advanced students in rehabilitation professions. It presents current, mainstream ideas that are worthy of further discussion and clinical application. It should be a part of the general library of clinical and educational therapy programs.

Elizabeth H Littell, PhD, PT

Idaho State Universty

Pocatello, Idaho