Surgical Rehabilitation of the Upper Limb in Tetraplegia.

Hentz VR, Leclercq C. Philadelphia, PA 19106-3399, WB Saunders Co, 2002, hardcover, 270 pp, illus, ISBN: 0-7020-2271-3, $75.

As the title implies, the authors of Surgical Rehabilitation of the Upper Extremity in Tetraplegia have written a book that focuses on the upper extremity, primarily on surgical interventions to address functional limitations following tetraplegia caused by spinal cord injury. Although the book focuses on surgical interventions, the authors do provide some information about nonsurgical interventions, such as muscle strengthening, range of motion, splinting, and adaptive devices. The book is intended for a variety of health care providers, including physicians, occupational therapists, physical therapists, and other allied health care professionals.

Part I of the book contains 6 chapters focusing primarily on background information and patient evaluation (the authors use the term evaluation to encompass both examination and evaluation). The section begins with a historical review of surgical rehabilitation, followed by chapters on anatomy, cervical spinal cord trauma, initial protection of the upper limb following injury, and rehabilitation considerations.

The last chapter in part I (chapter 6) is devoted to the examination of the upper limb. At 8 pages in length, the chapter is brief, and its content lacks adequate depth and discussion to be clinically meaningful. The corresponding appendix associated with the content in this chapter, however, is mislabeled. Although references in the text say that this appendix contains several examples of examination formats, it actually only contains one hand surgery evaluation form. Incidentally, this same form is provided as a figure in the evaluation chapter itself.

Part II of the book contains 12 chapters and focuses on the surgical and nonsurgical rehabilitation of upper-extremity function. This part contains excellent information about specific surgical procedures and techniques. Some chapters in this part contain rehabilitation recommendations that would be relevant for physical therapists. Furthermore, the book has 3 appendixes with postoperative rehabilitation protocols for specific surgical procedures discussed in the text. Although the chapters are quite detailed and include some postoperative rehabilitation information, the chapters in part II are, for the most part, too focused on surgical details to be meaningful to practicing clinicians.

The authors do well in emphasizing the need to look beyond muscle strength and range of motion when determining the appropriateness of surgical intervention. Throughout the book, they consistently refer to the importance of patient motivation, family and caregiver support, and a realistic outlook regarding the length of the recovery process and the expected outcomes of surgery. These are important considerations that are often overlooked.

A few concerns did surface while I read the book. First, some illustrations and one appendix are mislabeled or incorrectly referenced within the text. Second, in some places, the text does not match the illustrations that it references. In one of the surgical chapters, for example, the text states that the elbow should be immobilized in full extension. The caption on the corresponding illustration, however, indicates that the elbow is casted in about 15 degrees of flexion. Although these inconsistencies may be minor, they could confuse the reader. Third, many of the references in the book were outdated. In the 2 most relevant chapters for physical therapists, "Initial Protection of the Upper Limbs" (chapter 4) and "The Tetraplegic Patient and the Environment" (chapter 5), only 5 of 34 references were published after 1995. Fourth, the authors do not provide much information on the outcomes of the surgical interventions they describe. Most of the outcomes information is based on the authors' clinical experience and on their own patients; only on one occasion do they provide references to support this information.

Physical therapists and occupational therapists specializing in postoperative hand therapy may find Surgical Rehabilitation of the Upper Extremity in Tetraplegia of value. Clearly, a thorough understanding of surgical techniques can enhance a clinician's understanding of appropriate postoperative rehabilitation interventions. Given the technical nature of this book, I do not recommend this book for clinicians seeking information about upper-limb evaluation or rehabilitation activities before or after surgery for patients with tetraplegia.

Kirsten A Barrett, PT, PhD

Virginia Commonwealth University 

Richmond, Va

Dr Barrett is Senior Research Associate at the Survey and Evaluation Research Laboratory. She provides clinical coverage at Sheltering Arms Rehabilitation Hospital.