Muscle and Sensory Testing.

Muscle and Sensory Testing Reese NB. Philadelphia, PA 19106, WB Saunders Co, 1999, spiralbound, 544 pp, illus, $45.

The title of this text, Muscle and Sensory Testing, barely does justice to the scope of information covered. In the preface, the author states that her goal was to bridge the gap between manuals that cover the neurological examination and manuals that cover muscle testing in detail. She has done this and more. This book is a well-organized and clearly illustrated spiralbound text that is easy to navigate.

Chapter 1 provides the historical perspective for manual muscle testing and discusses the reliability and validity of these tests. The methods for performing manual muscle testing and the system for grading are described. The next 3 chapters cover techniques of manual muscle testing for the upper extremities; head, neck, and trunk; and the lower extremities. These chapters include both line drawings for the anatomy and photographs of the method, along with written instructions, verbal commands, and possible substitutions by the patient during testing. When more than one method has been advocated for testing a muscle, the author includes and references the options.

Chapter 5 covers pediatric muscle testing for infants under 1 year old. Because infants cannot respond to instructions and commands from the examiner, testing depends on normal motor developmental activities and strength development against gravity. If this book were to include any additional information, I would have found it helpful for this chapter to cover primitive reflexes and their integration and to provide suggestions for testing toddlers.

Chapter 6, "Handheld Dynamometry for Muscle Testing," will be useful to therapists who use a handheld dynamometer in their clinical practice or in research or for those therapists who might be considering using it for greater objectivity in their evaluations. It discusses reliability, validity, and clinical utility and provides normative values. Photographs and written instructions for muscle testing using the dynamometer are clear and concise.

In chapter 7, the focus of the book shifts to sensory testing. The therapist is given information on testing procedures for the spinal cord tracts using

pain, light touch, temperature, vibration, and proprioception. Deep tendon reflex testing is also covered in this chapter. Chapter 8 provides instruction for the remainder of the general neurologic screening examination, including cerebral function testing (eg, memory), cerebellar function testing (eg, coordination), and cranial nerve tests. This chapter also includes testing techniques for the cutaneous reflexes, such as the Babinski reflex and the cremasteric reflex.

The final chapter is on observational gait analysis, which identifies muscle weakness in the lower extremity. Photographs of the normal gait cycle are included, with a written description of deviations and possible etiologies. Of all the chapters in the book, I found this one to be the least helpful because it illustrated normal gait but not abnormal gait.

Both physical therapist students and clinicians will find this text to be a reference to be kept close at hand. The author has certainly accomplished her stated goal and has written a book that is easy to use and that has clear diagrams. If you are looking for a manual on neurological examination to add to your library, I highly recommend that you consider this book.

Maggie Fillmore, PT, OCS Kaiser Permanente Oakland, Calif

Ms Fillmore is a clinical specialist at Kaiser and a faculty member with the Kaiser Residency Program in Advanced Orthopaedic Manual Therapy.