The Clinical Science of Neurologic Rehabilitation, ed 2.

Dobkin BH. New York, NY 10016, Oxford University Press Inc, 2003, hardcover, 614 pp, illus, ISBN: 0-19-515064-3, $125.

This second edition of Neurologic Rehabilitation has been aptly retitled The Clinical Science of Neurologic Rehabilitation, because it reflects the latest knowledge and clinical application of research in this everchanging field. The book is divided into 3 parts: "Neuroscientific Foundations for Rehabilitation," "Common Practices Across Disorders," and "Rehabilitation of Specific Neurologic Disorders."

Topics covered in part I include central nervous system plasticity, central pattern generators, and the implications for rehabilitation following central nervous system lesions. Biologic adaptations and neural repair are explained, along with the intrinsic and extrinsic factors affecting nerve and muscle tissue changes following nervous system damage. Functional neuroimaging techniques--such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other high-tech, specialized testing methods--are described in part I. This part also discusses how these techniques are applied in scientific research to learn about changes in the brain after central nervous system damage and after training interventions or medication. Potential future uses of neuroimaging techniques in rehabilitation are highlighted, in addition to the potential use of computers and micromachines to reduce patients' impairments and disabilities.

Part II, "Common Practices Across Disorders," first provides an overview of the rehabilitation team, with discussion of some of the traditional and newer approaches in physical therapy, occupational therapy, and speech-language therapy and the roles of neuropsychologists, social workers, and recreational therapists as part of the interdisciplinary team. Because walking is frequently top priority for many patients, one chapter is devoted to this topic. Normal gait and typical gait deviations in hemiparesis, paraparesis, and peripheral neuropathy are described. Approaches to retraining ambulation--which include conventional training approaches--and pros and cons of the more recently developed body weight-supported treadmill training also are described.

Following this material is a thorough discussion of assessment and outcome measures (along with types of validity and reliability) and how to choose the appropriate measurement tool for a particular situation. Tables clearly organize the various tools available to measure neurologic impairments. Examples of several scales are provided, including the Barthel Index of Activities of Daily Living, Functional Independence Measure (FIM), Modified Ashworth Scale, Modified Rankin Scale, and the Fugl-Meyer Assessment Scale. Advantages and limitations of the various measurement methods are discussed.

Part 3, "Rehabilitation of Specific Neurologic Disorders," elaborates on the epidemiology, medical interventions, therapeutic interventions, and outcomes of patients with strokes, acute and chronic myelopathies, traumatic brain injuries, and other central and peripheral nervous system disorders. Discussion of current approaches to management of these disorders and related secondary problems is well supported through references to the latest research in neurologic rehabilitation.

This book is well organized, with an outline of highlights at the beginning of each chapter, extensive reference lists at the end of each chapter, a detailed index, tables to organize information, case studies to elaborate on clinical applications, and photographs and diagrams to illustrate equipment and some of the neuroimaging tests. Each chapter is packed with quite up-to-date information but without redundancy. I believe The Clinical Science of Neurologic Rehabilitation would be a wonderful textbook for physical therapist students as well as an invaluable reference and educational tool for experienced physical therapists.

Janice Bohn, PT, NCS 

Rehabilitation Institute of Chicago at

Alexian Brothers Medical Center

Elk Grove Village, Ill

Ms Bohn is a physical therapy clinical facilitator and clinician primarily responsible for the rehabilitation of patients with neurological conditions.