Pulmonary Management in Physical Therapy.

Zadai CC, ed. New York, NY 10011, Churchill Livingstone Inc, 1992, hardback, 234 pp, illus, $24,95.

Pulmonary Management in Physical Therapy is part of the Clinics in Physical Therapy Series. The writing style, organization, and relatively short length of this book make it very readable and easy to understand. Although relatively short, it is brimming with information that would be useful to any physical therapist. In fact, the book's editor states in the first few paragraphs of the preface that pulmonary management and evaluation of pulmonary status should be within the domain of every physical therapist and not something reserved only

for the "chest PT specialist."

The first chapter reviews the anatomy and physiology of ventilation in relationship to the total gas delivery system. Updated information, based on recent research regarding the functions of specific muscles during ventilation, is presented along with the controversies surrounding the ventilatory functions of specific muscles, particularly the intercostals. Other information covered in this chapter enables the reader to envision the overall integration and coordination of the physiological mechanisms that are involved in breathing, including respiratory muscle composition with regard to fiber type, and the effects of age, gender, and posture on ventilation. Subsequent chapters stress the interrelationship between the cardiac and pulmonary systems, as well as a discussion of exercise pathophysiology that is linked to pulmonary impairment. Several conditions that are commonly treated by physical therapists, including spinal cord injury, cerebrovascular accident, muscular dystrophy, poliomyelitis, and Guillain-Barre syndrome, are analyzed with regard to their effect on pulmonary dynamics.

The section on identifying pulmonary limitations by using comprehensive physical therapy evaluation techniques would be particularly relevant to clinicians. The techniques described here include items such as the interview, physical observation, palpation, percussion, and auscultation, along with more sophisticated measures such as thoracic imaging, pulmonary function tests, arterial blood gases, the determination of oxygen consumption, and carbon dioxide production through analysis of expired gases.

Entire chapters are devoted to body positioning and exercise conditioning and their influence on cardiopulmonary dynamics. Chapter 6 addresses the traditional manual techniques that are used in chest physical therapy. These include the familiar percussion and vibration technique, along with other, more sophisticated techniques. Here again, controversies surrounding the effectiveness of these techniques are covered. in another chapter, breathing exercises, including their physiologic basis and implementation, are covered very thoroughly.

"Clinical Decision Making," the ninth and final chapter, ties everything together. Particularly useful is the presentation of three case studies that include information about evaluation data, goals, and treatment protocols, which tracks the patients from acute intervention through discharge. Whether you consider yourself to be a "chest PT specialist" or not, I think you will find this book to be a useful basic reference. Although there are more detailed and complex books about the lung and pulmonary function on the market, this book does offer something useful for every practicing physical therapist.

John P Sanko, PT Univ of Scranton Scranton, Pa