Neuromusculoskeletal Examination and Assessment: A Handbook for Therapists.

Neuromusculoskeletal Examination and Assessment: A Handbook for Therapists Petty NJ, Moore AP. Philadelphia, PA 19106-3399, Churchill Livingstone Inc, 1998, paperback, 347 pp, illus, $19.50.

This text is literary proof of the dynamism of the field of neuromusculoskeletal management. Imagine a time line of authors, practitioners, therapists, and physical techniques weaving throughout a reference book about the examination and treatment of joint structures; this is what Petty and Moore convey in their text. Many of the most influential theorists are represented: Butler, Cyriax, Edwards, Elvey, Grieve, Janda, Jull, Richardson, Kaltenborn, Lee, McConnell, McKenzie, Maitland, and Mulligan. The authors have taken the ideas from this international pool of theorists and developed a working manual tot the "unified approach to the examination and assessment of neuromusculoskeletal dysfunction."

The text is appropriate for physical therapists with varying degrees of clinical experience. For new clinicians, the text introduces them to the clinical world of neuromusculoskeletal dysfunction. The experienced clinician can use the text as a resource to continually renew his or her clinical skills.

The text is a detailed reference that provides various learning models. For example, the beginning physical therapist can use the text in an academic learning model to enhance his or her clinical skills. The experienced physical therapist can use the text to direct his or her learning model toward direct patient care.

The book's strongest points are its organization of clinical thought processes and its research and theoretical references. The first 98 pages deal with the subjective and physical examination of joints. Chapter 2, "Subjective Examination," emphasizes the communication between the patient and the practitioner. It is a "how-to" chapter on the gathering of information on patients' physical and emotional condition. The well-conceived chapter 2 accurately transforms behavior of patient symptoms from an oral presentation to a written presentation in the form of body charts and medical notes. Chapter 3, "Physical Examination," is a natural progression from the preceding chapter. The authors state that "the aim of the physical examination is to determine what structures are responsible for producing the patient's symptoms." The chapter is well supported by diagrams, charts, and pictures.

In the succeeding 12 chapters, the reader is presented with a joint-by-joint guide to the subjective and physical examination of the temporomandibular structure, spinal column, and upper and lower extremities. The book never deviates from its didactic approach. Through subjective discourse, each chapter covers possible causes of pain or limitation of movement, reinforced by body charts, behavior patterns, special questions, history of current conditions, past medical history, and social and family history. From here, a plan for physical examination is begun with observation, joint tests, muscle tests, neurological tests, special tests, functional ability tests, palpation, accessory movements, and completion of the examination.

In conclusion, Neuromusculoskeletal Examination and Assessment: A Handbook for Therapists is a working reference book that should be on the shelf and in the daily minds of all physical therapists who have a desire or a talent in the neuromusculoskeletal field.

Randy Brown, PT
Petersburg, NJ

Mr Brown is a contract physical therapist and home care physical therapist.