The Sensitive Nervous System.

The Sensitive Nervous System Butler DS. Adelaide, Australia, Noigroup Publications, 2000, hardcover, 431 pp, illus, ISBN: 0-646-40251-X, $95.

The purpose of this text is to update the author's previous book, Mobilisation of the Nervous System, and to expose the reader to new concepts in neurobiology related to managing patients using movement-based therapy. This book is intended for clinicians and researchers who are involved with the "movement based professions." Clinical perspectives and implications are brought up continually throughout the book.

There are 16 chapters in this book. Each chapter has its own references and separate conclusions. One of the book's biggest themes is the use of specific methods for examining the nervous system (referred to as "neurodynamics"), which is consistently reinforced in each chapter. The book begins with a comprehensive history of manual therapy and neurodynamics. Chapters 2 through 5 present background material on neurodynamics and how the central and peripheral nervous systems function in normal and pathological states. Chapter 2 explores how our nervous system functions normally. The third chapter is centered on pain mechanisms. The section on abnormal impulse generating sites is of particular interest. The fourth chapter concentrates on the central nervous system, and it explains relationships among the neuroendocrine system, the immune system, and the autonomic nervous system. The fifth chapter is dedicated to neurodynamics.

Chapter 6 deals with clinical decision making, and discusses the importance of evidence-based practice. One of the other areas of emphasis was the pathobiology associated with injury to the tissues and with pain itself. Chapter 7 starts the assessment section with a broader view of the patient, including psychosocial "yellow flags," which are examination findings that would make the therapist cautious when proceeding with further testing. The eighth chapter explains palpation of the nervous system in detail, whereas manual assessments are covered in the next chapter. This ninth chapter includes references to all of the classic tests for sensation, motor function, reflexes, cranial nerves, and the autonomic nervous system.

Chapter 10 describes the relevance of performing the various neurodynamic tests and includes some clinical examples. Chapters 11 and 12 cover the neurodynamic testing of the spine and the lower and upper limbs. Both active and passive testing maneuvers are described and are accompanied by clear illustrations. Chapter 13, which was not written by the author, critically examines neurodynamics from a research standpoint and discusses the available studies. This chapter also includes definitions and background information related to research in general. Chapter 14 presents the integration of neurodynamics into the treatment strategy and discusses postural considerations and active and passive mobilization techniques. The last chapter looks at neurodynamics and specific pathology (ie, carpal tunnel syndrome and double crush syndrome).

Overall, this book is very well written. The illustrations and tables are clear and concise. The material is explained with generous use of analogies and examples that make some of the complex principles easier to comprehend. The text is well referenced and up to date. Throughout the book, the author suggests other texts or articles to which the reader can refer for further detail. I would highly recommend this book to any physical therapist in any setting.

Jeff Yaver, PT
Kaiser Permanente Medical Center
Sacramento, Calif

Mr Yaver is the Assistant Manager of Outpatient Services for the Rehabilitation Services Department. His clinical interests include management of spinal dysfunction.