Primary Care of the Functionally Disabled: Assessment and Management.

Primary Care of the Functionally Disabled: Assessment and Management This comprehensive text was written by specialists in rehabilitation medicine. Their primary purpose was to educate physicians who undertake primary care of patients who have potentially chronic disabilities.

The authors are proponents of management of chronic injury that includes assessment of daily living and working activities. Their functional approach to medical practice encourages physicians and other professionals to recognize the importance of a patient's actual function in daily living. The authors provide rationales, functional evaluation techniques, and case studies to illustrate the management of patients' capabilities and disabilities. In addition, specific suggestions for referral to other medical specialties are defined clearly.

The book covers three major areas. The first area outlines the importance of functional evaluation and methods. Specific protocols for examination are described, with examples of documentation included. The second portion of the book provides an overview of physical interventions in rehabilitation treatment and the roles of clinical specialists who form the interdisciplinary rehabilitation team. The last portion of the book specifically covers diseases and conditions that have chronic implications. Regarding these, there are two outstanding chapters: one on stroke and another on multiple sclerosis. These chapters are especially strong in their symphatetic and comprehensive approach to patients. Helpful information is also found in other chapters detailing cardiopulmonary conditions, Parkinson's disease, back pain, visual and hearing impairments, mental dementia, and retardation. The chapter on cerebral palsy was notably lacking in discussion of the need for early intervention.

The text is very well organized, and information is easy to find. Most sections are comprehensive and serve as a guide not only for physicians but for other medical specialists interested in the specific topic. Several charts and giagrams detail examination protocols.

Those readers with a rehabilitation background will especially appreciate the authors' strong support for multi-disciplinary rehabilitation and functional evaluation. Particularly in the sections on specific disabilities, the humanistic interest in the whole patient comes through.

How the subject of physical therapy is handled depends on the author of the individual chapters. Because physical therapy modalities are described in detail in an early chapter, one may get the impression that these physical therapy modalities could be used in a physician's office and not necessarily by a physical therapist. Although the authors do discuss referral to physical therapists, they leave the responsibility for deciding on physical therapy to the physician. This may strike a discordant note for therapists who practice professional evaluation for treatment. On the other hand, several chapters on specific rehabilitation do bring out the qualities of a physical therapist as part of the team. The chapter on back care particularly covers the newer philosophies of the physical therapist in broadening basic treatment into the return-to-work realm.

Physical therapy professionals, especially those involved with primary-care physicians or rehabilitation, may benefit by reviewing some of the functional assessment procedures that physicians use. In addition, physical therapy practitioners who are unfamiliar with certain diagnostic categories might benefit from an overview of the evaluation and treatment of those diagnoses by functional approach. The text has a definite role in the rehabilitation and functional disciplines.