Therapeutic Modalities, ed 2.

Therapeutic Modalities, ed 2

Starkey C. Philadelphia, PA 19103, FA Davis Co, 1999, hardcover, 397 pp, illus, $41.

The first edition of this text was entitled Therapeutic Modalities for Athletic Trainers. In this newest edition, the author has replaced "athlete" with "patient," because everyone is a patient when injured, even athletes. However, the author denies that this change was made to broaden the intended audience of the text.

This book is well written and concise. Written in a systematic manner, it is similar to other modality texts in the sequence and content of its chapters. It becomes clear very early on that this text is written for novice students. The chapters begin with basic information and often aid students by reviewing information that they may have learned in other courses. The readers then progress to higher levels of information. As a means of quick reference, unfamiliar words or terms are italicized and then defined at the bottom of the page. Each chapter ends with a multiple-choice and short-answer quiz.

The first chapter, "The Injury Response Process," begins with a short synopsis on the cell's response to stress followed by a discussion on different tissue types. The author then discusses the injury process, concluding with a section on the role of therapeutic modalities to control or limit the negative effects of inflammation.

Chapter 2, "The Physiology and Psychology of Pain," provides a thorough discussion of the pain process, historical and modern theories of pain control, and pain assessment scales. The chapter concludes with short summaries of the placebo effect, referred pain, chronic pain, and pain management techniques, with an emphasis on physical, behavioral, and cognitive means for controlling pain.

"Development and Delivery of Treatment Protocol," the third chapter, emphasizes the problem-solving approach. The authors successfully attempt to instill in their readers the idea that therapeutic modalities should not be applied in a "cookbook" fashion; rather, patients should be treated according to their individual needs. A case study allows readers to follow the author as he presents the 4 stages of problem solving: (1) recognition, (2) prioritization, (3) goal setting, and (4) treatment planning. The rationale for each treatment choice is provided. Short discussions on documentation and legal considerations follow.

The fourth chapter, "Thermal Agents," discusses the physiologic effects of cold and heat modalities. An interesting discussion that compares and contrasts the application of heat and cold modalities follows. The application techniques of various thermal agents are described in detail, including treatment duration, indications, and contraindications. Overall, this chapter was well written and made excellent use of figures, charts, and pictures to explain and demonstrate various concepts and techniques.

Chapter 5, "Electrical Agents," is the lengthiest chapter. It reviews the fundamentals of electricity and different classes of stimulating currents, different means of measuring current flow, and series and parallel circuits. Informative figures help readers understand these concepts. The author then describes electrical generator characteristics and how they may affect treatment and the various excitable and nonexcitable tissues in the body. An informative discussion of electrodes follows that includes size and placement (ie, monopolar, bipolar, quadripolar), with accompanying illustrations.

The author provides a short synopsis on the movement of electricity through the body, which introduces the concept of rheobase. This synopsis is followed by a section on the Law of Dubois Reymond and a substantial discussion of common electrical stimulation goals and the possible means of achieving them (ie, muscle contractions, strength augmentation, pain control, wound healing, control of edema, fracture healing). The chapter concludes with a lengthy and practical section on setup and application techniques of various electrical stimulators, including microcurrent electrical stimulation and iontophoresis.

"Ultrasound," the sixth chapter, provides in-depth coverage of ultrasound (US) waves, including concepts such as wave frequency, power, intensity, beam nonuniformity, treatment duration, and dose-oriented treatments. The author then provides short discussions on the penetration of US through different bodily tissues, modes of US application, and US coupling agents, proceeding to examine the biophysical effects of US and the influence of US on the injury process, including blood flow, tissue healing and stretching, and pain control.

The final chapter, "Mechanical Modalities," is a well-written, easily understandable discussion of how intermittent compression, continuous passive motion, biofeedback, cervical traction, and therapeutic massage influence the injury process. This discussion includes possible biophysical considerations and application techniques.

Four appendixes provide illustrations of trigger points and pain patterns; summaries of the physical properties governing therapeutic modalities, including concepts such as the electromagnetic spectrum and physical laws (eg, cosine and inverse square laws, the Arndt-Schultz Principle, and the Law of Grotthus-Draper); illustrations depicting various motor points throughout the body; and a list of medical shorthand. A fairly extensive bibliography is included.

Overall, this is a fine text. It is informative, easy to read, and up to date on the latest research. The author makes excellent use of diagrams and illustrations for teaching purposes, and the "instructional boxes" throughout the text were very insightful. This text is recommended for use in physical therapist and physical therapist assistant courses, and for clinicians who want to review the application techniques for various therapeutic modalities.

James L Karnes, PhD, PT D'Youville College Buffalo, NY

Dr Karnes is Associate Professor in the physical therapy program. His research interests include the influence of physical agents on soft tissue injury and repair.