Rehabilitation of the Physically Disabled Adult.

Rehabilitation of the Physically Disabled Adult

Edited by Goodwill CJ, Chamberlain MA. London EC4P 4EE, England, Croom Helm (distributed by Sheridan House Inc, Dobbs Ferry, NY 10522),1988, paper, 881 pp, illus, $45

Fifty-five clinicians from the United Kingdom present a comprehensive view of the many phases of rehabilitation, to guide those preparing for the diploma in medical rehabilitation and to orient other practitioners. The physician-editors organized the book into eight parts. The first part defines and assesses the rehabilitation problem. Although statistics are derived from British surveys, the population trends apply to the American scene. most of the social and psychological aspects also transcend national boundaries.

The next four parts relate to musculoskeletal, cardiopulmonary, communication, and neurological clinical disorders. Luff, a medical officer at the country's major prosthetics facility, offers an overview of amputation incidence, prevalence, and etiology in England. He emphasizes the importance of having a physical therapist on the management team, both for preoperative and postoperative care. Surgical considerations and levels are highlighted. Basic prostheses for below- and above-knee amputees and those with knee disarticulation are illustrated, although prescription rationales for specific components are minimal. Luff ignores substantial evidence supporting the use of rigid and semirigid early dressings; he recommends minimal dressing to allow limb inspection. Similarly, he warns against treating long below-knee limbs, anticipating prosthetic problems; this warning disregards published reports of amputees with longer limbs who enjoy greater walking speed and economy. Upper-limb prosthetics receives cursory attention. Part 6 summarizes the treatment rendered by various professional workers. Disabilities that affect patients with diverse diagnoses also are addressed, such as urinary incontinence, sexual problems, and skin and dental care. The chapter on physiotherapy is written by three superintendent therapists. They quote from the Chartered Physiotherapists' Source Book, which defines the profession as "a systematic method of assessing musculoskeletal and neurological disorders of function, including pain and those of psychological origin, and treating or preventing those problems by natural methods based essentially on manual practice and physical agencies." The authors expand this definition to include treatment of chest, skin, and circulatory disorders. Practice is described in terms of physician referrals, although therapists also perform advisory, preventive, and health education roles. Postregistration education is deemed essential by the Chartered Society of Physiotherapy. Treatment involves various types of exercise, relaxation, hydrotherapy, postural drainage, transfers, neuromuscular reeducation, manipulation and mobilization, traction, massage, electrotherapy, and heat and cold therapy. A case history of a stroke patient illustrates the application of selected modes of therapy.

Part 7 covers equipment for seating, wheelchairs, transfers, orthoses, walking aids, car driving, and environmental control. Regarding orthoses, Goodwill, the senior editor, advocates that the prescription include the aims of the device; information on joints to be treated, materials, and pressure-sensitive areas; and considerations of donning, fastening, and appearance. Described are basic biomechanical principles and representative orthoses for the foot and knee for persons with arthritis and diabetes. Components for the flaccid and spastic foot, knee, and hip are suggested. A discussion of a few cervical orthoses, corsets, and arm orthoses completes the chapter.

The last part of the book relates to delivery of services in the United Kingdom. Each chapter of the text concludes with references. Nearly all the chapters include a few photographs, charts, and drawings. A detailed index aids in locating specific material.

As might be expected, a global reference text cannot provide complete coverage of individual topics; nevertheless, a more useful approach would have been to define the full scope of the field, then to provide as many examples as space allowed. Surprisingly, in spite of the book's title, the contributors do not deal with the specific problems of geriatric patients. Although the terminology, spelling, and administrative implications are parochial, much of the text will interest physical therapy practitioners who seek a quick view of a particular clinical situation.

Joan Edelstein