Orthotics and Prosthetics in Rehabilitation.

Orthotics and Prosthetics in Rehabilitation Lusardi MM, Nielsen CC, eds. Woburn, MA 01801-2041, Butterworth-Heinemann Inc, 2000, hardcover, 636 pp, illus, ISBN: 0-7506-9807-1, $99.

The editors and the chapter authors have created an excellent textbook for the multidisciplinary team of health care professionals who work with people requiring orthoses and prostheses. This well-written book describes the use of prostheses and orthoses in rehabilitation in detail, taking the reader from prevention to fabrication, to training, to the everyday use of these devices.

The book is divided into 3 sections. Section I covers basic information in prosthetic and orthotic rehabilitation, including chapters on the multidisciplinary team, materials and technology, and clinical assessment of gait as well as a much-needed and well-written chapter on the energy costs of ambulation for people with lower-extremity impairments. This chapter emphasizes the cardiopulmonary costs of ambulation and the rehabilitation needs of older patients, a patient population that often uses orthotic and prosthetic devices.

The second section consists of 14 chapters covering orthoses in rehabilitation. Beginning with chapters that discuss the basics of orthotic design and assessment, subsequent chapters address orthotic use beginning at the foot and moving proximally to the spine and upper extremities. The chapters are well written with numerous diagrams and photographs that provide clarity. The chapter on splinting for the hand is very useful for physical therapists who want to be more familiar with the types of orthoses that are most commonly fabricated and applied by occupational therapists. In any clinical setting in which occupational therapy may not be readily available or in which the physical therapist could be responsible for splint management, this chapter provides basic information for the indications and fabrication of splints. The case studies in the hand splinting chapter are a valuable teaching tool that helps bring together the concepts of upper-extremity splinting.

Although physical therapists are not often involved in the fabrication of lower-extremity casts, the book contains a well-written chapter explaining the principles of casting and orthoses for extremity fractures. The final chapter in this section describes the use of orthoses for burn management. Because many physical therapists are unfamiliar with this topic, this chapter would benefit from more pictures that show how these splints (orthoses) are used with patients with burns.

The third section of this text is extraordinary in its coverage of prostheses in rehabilitation. Though there is some overlap of the information in various chapters, this overlap does not detract from the usefulness of the information to practicing clinicians, educators, or students. The section begins with basic information on amputation and its prevention. From this beginning, the reader is led from pre-prosthetic considerations through the management of patients with a foot amputation and patients with high-level and bilateral amputations. Chapter 28, which covers the rehabilitation of people with transfemoral amputations, is noteworthy for its emphasis on the function and importance of the pelvis in prosthetic gait. The author of this chapter does an excellent job of describing gait training and the necessity of retraining the patient to incorporate proper pelvic motion. The part of this chapter that describes the use of a prosthesis for activities of daily living, however, would benefit from less description and more photographs. Photographs would more clearly show the activities that the author is describing and would make the reading less tedious.

The final 2 chapters in this section cover children with limb deficiencies and upper-extremity amputation and lay the groundwork for a basic understanding of these patient populations. A more comprehensive text on these topics, however, would be needed for readers to develop proficiency in these areas.

This comprehensive and well-written text should be part of any program library, rehabilitation department, or prosthetics and orthotics course. The services of physical therapists, occupational therapists, and prosthetists/ orthotists will find themselves well-represented and respected as parts of the multidisciplinary team for people who need orthoses and prostheses.

Melissa Wolff-Burke, PT, EdD, ATC
Shenandoah University
Winchester, Va

Dr Wolff-Burke is Assistant Professor and Director of Clinical Education in the Division of Physical Therapy. Her teaching responsibilities include the classes "Prosthetics and Orthotics" and "Introduction to Physical Therapy." She directs a summer camp for children with amputations and has a clinical practice in outpatient orthopedics.