Lower Limb Prosthetics: 1998.

Lower Limb Prosthetics 1998 Berger N, Fishman S, eds. New York, NY 10016-8301, New York University Health Sciences Bookstore, 1997, softcover, 164 pp, illus, $19.95.

Norman Berger and Sidney Fishman, the retired directors of the New York University Prosthetics and Orthotics Program, have updated this 40-year-old publication. In the preface, they state that this text grew out of reference notes prepared for students attending prosthetics and orthotics courses at New York University Medical Center starting in the early 1950s. This publication has progressed through a number of editions to become a classic introductory interdisciplinary text in the field of lower-limb prosthetics. This text provides basic information to physicians, surgeons, physical therapists, and prosthetists concerned with the care of persons with amputations.

Fourteen chapters contain descriptions of the consequences of amputation; normal gait and gait analysis; biomechanics; prosthetic components of transtibial, transfemoral, and other amputation types; prosthetic management procedures; activities training; and prosthetic evaluation. This text contains an excellent description of prosthetic components, including energy-storing feet with indications for use. Photographs and illustrations of various prosthetic components are included. Explanations of newer transtibial sockets and suspensions such as the Icelandic-Swedish-New York University (ISNY) and the Roll-On Sleeve are also given. The tables add in-depth descriptions of knee assemblies, transfemoral suspension methods, and functional capacities. The medical prosthetic summary and prosthetic prescription forms are a nice addition. These forms can be readily used by physical therapists who are working with patients with amputations.

The strengths of this text include the chapters on functional abilities for persons with transtibial and transfemoral amputations, which provide in-depth descriptions of ambulation training activities. A unique chapter in this text compares gait training with fluid-controlled devices to gait training with mechanical friction knee units. The last chapters of the text contain information on gait deviations analyzed during various parts of the gait cycle and the assessment or checkouts of finished prostheses.

The negative aspects of this text include the use of older gait terminology such as "heel strike" versus the newer Rancho Los Amigos (RLA) terminology such as "initial contact." The book could have included more references to current literature concerning medical aspects, an evaluation of prosthetic components, and a more detailed description of Narrow M-L transfemoral sockets and hydraulic knees. The chapter on persons with bilateral amputations is very brief. A description of the implications of prostheses on pediatric patients with amputations would be helpful. A chapter on gait and activities training is present, but the text could have used more information on balance and coordination activities that are important in preprosthetic training. In addition, there is no index of the text, and the photographs of prosthetic components are very small.

Overall, this text is a nice addition to the library of physical therapists and students. It could supplement other texts that might offer a better review of medical problems, case studies, and preprosthetic training provided by physical therapists.

Ron Seymour, PhD, PT SUNY Health Science Center at Syracuse Syracuse, NY

Dr Seymour is Associate Professor in the physical therapy education program. He teaches in the areas of prosthetics and orthotics, orthopedics, management, and research.