Movement Science: Foundations for Physical Therapy In Rehabilitation, 2d ed.

Movement Science: Foundations for Physical Therapy In Rehabilitation, ed 2 Carr J, Shepherd R, eds. Gaithersburg, MD 20878, Aspen Publishers Inc, 2000, hardcover, 220 pp, illus, ISBN: 0-8342-1747-3, $55.

This book presents updated information on movement science and the revised therapeutic model, developed by Carr and Shepherd, for patients with neurological disorders (primarily patients with acquired central nervous system problems). The book is divided into 4 chapters. Each chapter is written by different contributors and has an extensive list of references.

The first chapter covers, from a historical perspective, theoretical frameworks for physical therapist interventions for patients with neurological disorders. The author presents a comprehensive critique of the facilitation approach, basing the critique on the use of the motor control model to analyze motor skill acquisition processes and the learned non-use phenomenon, which results from damage to the central nervous system. Two new subjects covered in this chapter are measuring functional outcomes to evaluate the efficacy of physical therapist interventions and the Nagi model of disablement.

In the second chapter, Carr and Shepherd present a revised motor learning model for patients with neurological disorders. The theoretical framework of the motor learning model is divided into the following sections: motor performance, skill acquisition, the rehabilitation environment, the effects of use and experience on recovery processes, and impairment underlying the functional disability. In the motor performance section, they discuss how a person who is healthy generates and controls muscle force, maintains balance, and reaches and manipulates objects. They then provide suggestions about treatment programs to address skill deficiencies in these areas. The authors argue that individuals acquire motor skills in specific stages as follows: goal identification, feedback, making errors, practice, unsupervised practice, and transfer of learning to perform the motor skill in different situations. The authors present evidence that the rehabilitation environment, the experiences of using the affected limbs during the recovery process, the primary motor impairments, the adaptive changes of muscle and soft tissues secondary to the motor impairments, and sensory and cognitive impairments all affect a person's ability to acquire motor skills. A list of instruments to measure functional outcomes is presented at the end of the second chapter.

In chapter 3, the author, AM Gentile, presents a detailed analysis of motor skill acquisition. Functional motor skills are analyzed on 3 levels: action, movement, and the neuromotor processes involved. A framework to categorize motor skills based on the environmental context and the functional role is presented. In the environmental context, she emphasizes that a person should practice motor skills in both a consistent environment and a changing environment. The most difficult task involves changes in both the person and the environment over trials. In the functional role context, the author discusses the impact of different relationships between the person (body) and the object in performing a motor skill. Gentile argues that a person learns a motor skill through both explicit learning, which is responsible for the rapid improvement observed in the initial practice period, and implicit learning, which is responsible for gradual changes over extensive practice. The author cites extensive literature in motor learning to support her claims. Numerous examples of designing treatment programs for patients with neurological disorders, using the principles of explicit and implicit learning processes, are provided.

Chapter 4 addresses the central nervous system's responses to injury and its natural recovery processes. The chapter author also reviews drugs that are used to limit the extent of damage and to facilitate recovery after the central nervous system is damaged. Factors influencing recovery of the central nervous system include 2 areas: biological and experiential. The author makes the following suggestions: (1) physical therapists should treat patients with central nervous system disorders as early as possible; (2) physical therapists should apply the treatment in a stimulating, varied, interesting, and challenging environment; and (3) the treatment should focus initially on daily activity skills and then on skills related to work and recreation.

The editors of this book are physical therapists, and they have produced this book for clinical physical therapists who work with patients who have neurological disorders. Each chapter author has integrated motor control theories into physical therapist interventions for patients with neurological disorders. Specific examples presented in chapters 2 and 3 will be helpful for physical therapists to develop treatment programs for patients with neurological disorders and to evaluate their efficacy. However, the language used in the book may be difficult for practicing physical therapists with limited background in movement science. The examples given in the book focus on a narrow area of skills for daily activities. The authors generally present key issues regarding the design of an intervention program; however, they do not provide details. Although the Nagi Model of Disablement was presented in the first chapter, patient examples given in chapters 2 and 2 did not follow the Nagi model. The authors present pieces rather than a comprehensive intervention program addressing functional skills for patients with neurological disorders.

Wen Ling, PT, PhD New York University New York, NY

Dr Ling is Chairperson and Associate Professor in the Department of Physical Therapy. Her research interests include movement analysis, pediatric physical therapy, and measurement of muscle function.