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Functional Neurorehabilitation: Through the Lifespan
Book Review
Book Review Bertoti Dolores B (2004): Functional Neurorehabilitation: Through the Lifespan, Philadelphia: FA Davis, 411 pp. ISBN 0 8036 1107 2 A lifespan approach is frequently used in schools of physiotherapy but most texts focus on a particular age or reference group. The lifespan approach and content of this book has much to offer students who are approaching neurorehabilitation for the first time. It would also be of value to entry level therapists coming to grips with putting theory into practice, and to physiotherapists in rehabilitation who work with a lifespan client population. The foundations for practice are set in the early chapters. A clear, logical, and reasonably comprehensive overview of neuroanatomy, neurophysiology, and the systems, including the sensory motor systems, which produce human movement is provided. Throughout these early chapters, reference to and examples from therapeutic techniques and clinical presentations are used to illustrate the links between theory and practice. Clear, unambiguous definitions of terms are provided with particular reference to some terminology that has led to confusion in the past. A comprehensive glossary of terms is included also at the end of the book The field of neurorehabilitation is dynamic and evolving and the author has successfully blended previously held theories and techniques with the newer theories and approaches to clinical management. The approach to intervention tends to follow the ICDH (1980) model but the reason is discussed fully in the Introduction. Although dynamic systems theory forms the basis or underlying theoretical approach to development and intervention, the way in which previously acknowledged approaches and techniques are integrated with the new, presents a balanced and logical clinical view. There is an interesting chapter on motor learning and the therapist as an educator. It brings together the theories of learning, as applicable to patients/clients, and teaching as it applies to the therapist. The knowledge presented in these background chapters is well referenced and up-to-date. The second part of the book focuses on an integrated approach to clinical management. The most commonly used techniques and approaches such as proprioceptive neuromuscular facilitation (PNF), neurodevelopmental treatment (NDT), sensorimotor, and neurophysiological approaches as well as the more contempory task-oriented and functional models are discussed in a way that encourages the clinician to choose the most relevant techniques for the management of specific clinical problems, impairments, or constraints. The clinical management of common clinical problems recognises that most clients requiring neurorehabilitation
Australian Journal of Physiotherapy 2004 Vol. 50
have complex impairments in motor, sensory, cognitive, perceptual, and social/emotional domains, however the focus of the text is on motor system problems. Clinical management of muscle weakness, abnormalities of tone, problems of coordination and involuntary movements are addressed through identification of the clinical problem, functional limitation, the intervention goals for the client/patient and a discussion of techniques that may be used to achieve these goals. A section in Chapter 6 provides questions that are helpful in guiding the therapist and client to explore together the main movement problems and thus determine the goals for intervention. Except in the chapter that focuses on the upper limb, paediatric clinical examples of intervention tend to be directed to pre and school aged through to adolescent children rather than to the younger and infant age groups where the systems are still developing and changing. In the introductory discussion to postural control and balance there is a lack of clarity in definitions with no clear differentiation between these two terms. Unfortunately the intermingling and synonymous use of the terms postural control and balance influences the discussion and presentation of examples throughout much of this chapter. Although in earlier chapters on clinical management of common clinical problems there is a paucity of information on assessment or evaluation, the discussion on assessment in the postural chapter is both helpful and practical. The reader needs to take care with the interpretation of the term anticipatory as a clear distinction is not made between the role of anticipatory (feedforward) muscle action timing in postural control and stability, compared to the anticipatory preparation of a limb for a specific task. The latter is well described in the management of the upper limb. The approach to management of the impaired lower limb is very comprehensive, factual, and practical. Although the book has been written principally for North American Physical Therapists and Assistants and makes reference to the APTA Guide to Physical Therapist Practice (1997), AOTA Occupational Therapy Practice Framework (2002), and to a workbook by the same author, this does not detract from the factual and clinical usefulness of the content. The format is consistent and structured throughout and the content is well organised making good use of tables to provide a summary or overview. Each chapter provides appropriate background information, a general approach, and then the management of more specific clinical problems providing a range of useful, practical techniques and management ideas. Physiotherapy students at all levels of training will find this text with its contemporary lifespan view of neurorehabilitation a very useful resource.
Yvonne Burns
263
Book Review Bertoti Dolores B (2004): Functional Neurorehabilitation: Through the Lifespan, Philadelphia: FA Davis, 411 pp. ISBN 0 8036 1107 2 A lifespan approach is frequently used in schools of physiotherapy but most texts focus on a particular age or reference group. The lifespan approach and content of this book has much to offer students who are approaching neurorehabilitation for the first time. It would also be of value to entry level therapists coming to grips with putting theory into practice, and to physiotherapists in rehabilitation who work with a lifespan client population. The foundations for practice are set in the early chapters. A clear, logical, and reasonably comprehensive overview of neuroanatomy, neurophysiology, and the systems, including the sensory motor systems, which produce human movement is provided. Throughout these early chapters, reference to and examples from therapeutic techniques and clinical presentations are used to illustrate the links between theory and practice. Clear, unambiguous definitions of terms are provided with particular reference to some terminology that has led to confusion in the past. A comprehensive glossary of terms is included also at the end of the book The field of neurorehabilitation is dynamic and evolving and the author has successfully blended previously held theories and techniques with the newer theories and approaches to clinical management. The approach to intervention tends to follow the ICDH (1980) model but the reason is discussed fully in the Introduction. Although dynamic systems theory forms the basis or underlying theoretical approach to development and intervention, the way in which previously acknowledged approaches and techniques are integrated with the new, presents a balanced and logical clinical view. There is an interesting chapter on motor learning and the therapist as an educator. It brings together the theories of learning, as applicable to patients/clients, and teaching as it applies to the therapist. The knowledge presented in these background chapters is well referenced and up-to-date. The second part of the book focuses on an integrated approach to clinical management. The most commonly used techniques and approaches such as proprioceptive neuromuscular facilitation (PNF), neurodevelopmental treatment (NDT), sensorimotor, and neurophysiological approaches as well as the more contempory task-oriented and functional models are discussed in a way that encourages the clinician to choose the most relevant techniques for the management of specific clinical problems, impairments, or constraints. The clinical management of common clinical problems recognises that most clients requiring neurorehabilitation
Australian Journal of Physiotherapy 2004 Vol. 50
have complex impairments in motor, sensory, cognitive, perceptual, and social/emotional domains, however the focus of the text is on motor system problems. Clinical management of muscle weakness, abnormalities of tone, problems of coordination and involuntary movements are addressed through identification of the clinical problem, functional limitation, the intervention goals for the client/patient and a discussion of techniques that may be used to achieve these goals. A section in Chapter 6 provides questions that are helpful in guiding the therapist and client to explore together the main movement problems and thus determine the goals for intervention. Except in the chapter that focuses on the upper limb, paediatric clinical examples of intervention tend to be directed to pre and school aged through to adolescent children rather than to the younger and infant age groups where the systems are still developing and changing. In the introductory discussion to postural control and balance there is a lack of clarity in definitions with no clear differentiation between these two terms. Unfortunately the intermingling and synonymous use of the terms postural control and balance influences the discussion and presentation of examples throughout much of this chapter. Although in earlier chapters on clinical management of common clinical problems there is a paucity of information on assessment or evaluation, the discussion on assessment in the postural chapter is both helpful and practical. The reader needs to take care with the interpretation of the term anticipatory as a clear distinction is not made between the role of anticipatory (feedforward) muscle action timing in postural control and stability, compared to the anticipatory preparation of a limb for a specific task. The latter is well described in the management of the upper limb. The approach to management of the impaired lower limb is very comprehensive, factual, and practical. Although the book has been written principally for North American Physical Therapists and Assistants and makes reference to the APTA Guide to Physical Therapist Practice (1997), AOTA Occupational Therapy Practice Framework (2002), and to a workbook by the same author, this does not detract from the factual and clinical usefulness of the content. The format is consistent and structured throughout and the content is well organised making good use of tables to provide a summary or overview. Each chapter provides appropriate background information, a general approach, and then the management of more specific clinical problems providing a range of useful, practical techniques and management ideas. Physiotherapy students at all levels of training will find this text with its contemporary lifespan view of neurorehabilitation a very useful resource.
Yvonne Burns
263