Rehabilitation of Movement: Theoretical Basis of Clinical Practice.

Rehabilitation of Movement: Theoretical Basis of Clinical Practice Pitt-Brooke J, Reid H, Lockwood J, Kerr K, eds. Philadelphia, PA 19106-3339, WB Saunders Co, 1998, paperback, 598 pp, illus, $69.

This text was written for physical therapist students and practitioners to provide a literature-based introduction to contemporary clinical approaches to movement rehabilitation. It also encourages readers to recognize the extent anti limitations of the scientific basis for current therapeutic approaches. The text focuses exclusively on the rehabilitation of movement related to musculoskeletal dysfunction as opposed to the sequelae of a central nervous system insult. The editors state that the text is not intended to be a comprehensive manual of therapeutic interventions, but was designed as an introduction to the scientific background of some current approaches to the management of musculoskeletal conditions.

The text is divided into 3 main sections that cover factors influencing movement; techniques for examination, evaluation, and treatment; and contemporary therapeutic approaches. Each of these 3 sections is preceded by a diagram that represents the section's contents and describes the interrelationships among the various topics covered. In addition, each chapter includes sidebars containing key points, clinical examples, and practical exercises designed to illustrate selected concepts. The authors make liberal use of both photographs and line drawings to supplement the text.

The first 3 chapters in the section entitle(1 "Factors Influencing Movement" cover terminology, musculoskeletal biomechanics and kinesiology, and the physiology of motor control. The second chapter covers biomechanical principles on a very basic level, and it discusses statics in a nonquantitative fashion and makes no attempt to introduce the relevance of dynamics to the movement of multisegmented limbs. Likewise, the chapter on motor control physiology takes a classical neuroanatomical approach and pays minimal attention to current motor control theory. In contrast, the last 2 chapters of section 1 provide much more in-depth coverage of 2 specific topics. "Neurodynamics" deals with the proposed importance of mechanical effects on neural tissue. The chapter on pain deals with both the neurobiology of pain and the application of these concepts to clinical practice.

Section 2 covers examination, evaluation, and measurement techniques. Chapter 6 introduces the basic principles of examination and evaluation and includes an overview of specific models of clinical reasoning. Chapter 7 covers principles of clinical measurement, presenting concise introductions to levels of measurement and issues of reliability and validity. It also includes specific information regarding goniometry and clinical measures of muscle strength. The final chapter of section 2 provides a brief introduction to gait analysis that includes information on the observational and instrumented methods of analyzing normal and pathological gait.

The final section is entitled "Contemporary Therapeutic Approaches to Clinical Practice." Chapter 9 reviews some passive manual therapy techniques and includes a useful discussion of current evidence on the effectiveness of passive movement techniques. The next 3 chapters provide a broad overview of concepts underlying some therapeutic exercise approaches and a review of the neuromuscular and cardiovascular effects of exercise. This section concludes with chapters on ergonomics, health education and communication, and the application of the cognitive-behavioral approach to rehabilitation.

The text is highly readable, and the liberal inclusion of illustrations and sidebars covering clinical examples and applications should make it appealing as an introductory text for physical therapist and physical therapist assistant students. A strength of the text is the breadth of topics it covers. It includes relevant information on clinical reasoning, measurement, health education, and the psychological aspects of rehabilitation that are not typically found in introductory texts concerning musculoskeletal rehabilitation. A drawback of the text is that, despite the stated aim of critically reviewing the scientific support for clinical practice, a great many of the supporting references are from other textbooks or review articles rather than from primary sources.

Dr Karst is Associate Professor and Assistant Director of the division of physical therapy education. His research and teaching interests focus on the application of biomechanics and motor control principles to the treatment of neuromusculoskeletal dysfunction.