Principles and Practice of Electrotherapy, 2d ed.

It was a pleasure to review the second edition of this book. I had previously reviewed both the first edition of the book in 1987 and a monograph published by Kahn in 1979 for Physical Therapy. The purpose of the second edition remains the same as the first, that is, to provide a practical manual for clinicians in the use of electrotherapy modalities.

The majority of the book is the same as the first edition and covers the electromodalities: diathermies, infrared, ultraviolet, cold laser, ultrasound and phonophoresis, electrical stimulation, transcutaneous electrical nerve stimulation, and iontophoresis. The information provided about these modalities is not new, but it is well organized and provides all the basic points needed to use the modalities. The second edition has provided new information on microampere electrical nerve stimulation (MENS) and thermography. The discussion on MENS provides only a brief overview and points out the need for more research on this modality. As with other editions of Kahn's book, the chapter on iontophoresis provides the best resource available on the theory and clinical use of iontophoresis. There is a table of commonly used ions, their dosage, and specific indications for the use of each. If one frequently uses iontophoresis, this chapter alone is probably worth the price of the book.

After a brief historical introduction to electrotherapy, Kahn uses the same format for each chapter. He discusses the physics and physiology of each modality, basic equipment operation (electrodes, controls, parameters, dosage, and so on), and indications and contraindications and then ends with specific treatment procedures. The information on physics and physiology is really only meant to give an overview and would not provide the theoretical background required of an entry-level physical therapist. It would probably be adequate for a physical therapist assistant (with the addition of some lecture material in some areas). I think that for the practicing clinician, however, the material provided is adequate to "refresh one's memory" about any particular modality. The treatment protocols, patient positioning, equipment setups, and dosage guidelines are excellent. Therefore, the text would be an excellent lab manual for use in educational programs for both entry-level physical therapists and physical therapist assistants.

Kahn devotes a chapter to testing procedures, which covers testing for reaction of degeneration with AC and DC currents and strength-duration curves. He admits, however, that these tests may have more of a historical than a practical importance. The discussion of thermography in the chapter on testing procedures gives only an overview of the topic, with some comments on the usefulness of the devices.

The author, in the chapter on treatment planning, tries to "bring it all together" by outlining treatment guidelines using the electromodalities. These treatment regimens are apparently based on Kahn's vast experience with these modalities rather than on "hard" scientific evidence. They will, however, offer the clinician a refreshing approach to many disorders, especially if one is not accustomed to using a lot of the modalities in patient treatment. For example, to treat calcific deposits, Kahn suggests acetic acid iontophoresis, ultrasound with or without hydrocortisone, and surged alternating current to the involved muscles. For the treatment of edema, a suggested regimen includes iontophoresis with hyaluronidase and surged alternating current. A perusal of this chapter will certainly provide clinicians with some new ideas on the use of electromodalities. Apparently one of Kahn's aims is to get clinicians to try new techniques as suggested by this quotation: "One of the most gratifying experiences for the clinician is attempting a new technique and finding the results successfull; so read, absorb, apply and enjoy."

As I see it, the strength of this book lies in the profuse use of photographs showing typical treatment setups. The photographs are well done and provide the clinician with a real "how to" manual, covering patient positioning and treatment, along with equipment and electrode setups. The use of the photographs makes it easy for the clinician to quickly implement a particular modality and the clinical setup.

Besides the photographs, there are numerous illustrations and tables that give treatment dosages and other pertinent clinical information. References are provided at the end of each chapter, citing both new and "classical" articles dealing with the electrotherapy modalities. Overall, the book will be useful to all physical therapy practitioners who use electrotheraphy modalities. However, if you already own the first edition of this book, I do not think there is enough new information to warrant the purchase of the second edition.

Thomas M Mohr, PT Univ of North Dakota Grand Forks, ND