Book Review

Case Studies and Treatment Examples Highlight Neuromuscular Text

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Neuromuscular Essentials: Applying the Preferred Physical Therapist Practice Patterns, edited by Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS, is a comprehensive text that can be utilized by physical therapy professionals in any setting to master the application of information presented in the American Physical Therapy Association's (APTA) Guide to Physical Therapist Practice.

Neuromuscular Essentials is one in a series of four books written to heighten the clinician's decision-making process based on the Guide when working with patients with neuromuscular deficits. The text focuses on the five elements of the patient/client management model: examination, evaluation, diagnosis, prognosis and intervention. Each chapter is dedicated to a specific practice pattern discussed in the neuromuscular section of the Guide, and the reader is instructed on using these five elements to develop an effective plan of care for a particular patient. The information presented in each chapter is enhanced with multiple case studies putting the five elements into practice.

Fifteen distinguished clinicians in the physical therapy profession have contributed their expertise to the chapters in this book. There are a total of nine chapters in the book that coincide with practice patterns A through I in the neuromuscular section of the Guide. Each chapter is neatly organized to assist the reader with clinical decision-making skills.

The authors provide introductory information at the beginning of each chapter, including an ample overview of anatomy, physiology and pathological conditions. Other pertinent information includes specific imaging tests used to facilitate a diagnosis, as well as the pharmacological management of certain pathological conditions. The lists of medications in the book are quite expansive, and contain imperative information regarding drug actions and side effects the skilled physical therapist should be aware of. All the brand-name drugs mentioned are listed in alphabetical order along with manufacturer information at the end of the book.

The case studies presented in the chapters discuss a myriad of patient-care scenarios involving the physical therapist. Topics include fear of falling in an elderly patient, Down syndrome, developmental coordination disorder, cerebral palsy with spastic diplegia, spina bifida, stroke, traumatic brain injury, Parkinson's disease, multiple sclerosis, carpal tunnel syndrome, Bell's palsy, unilateral peripheral hypofunction, vestibular disorders, Guillain-Barre syndrome, chemotherapy-induced peripheral neuropathy, spinal cord injury and patients in a vegetative state.

Chapter five, which discusses Parkinson's disease, contains several case studies characterizing the progressive stages of the disease in the same patient. This enables the reader to gain insight into the continuum of care for a patient with Parkinson's disease.

Each case study presented parallels the five elements of the patient/client management model. The case studies can be used as a guide for physical therapists to follow when working in the clinical setting. They begin with a brief introduction of the topic discussed. Following the introduction, the reader is taken through a thorough physical therapy examination.

The examination is very comprehensive, depicting a detailed history of the patient, followed by a systems review and specific tests and measures. The key points of the examination are bulleted to maintain organization and ease of reading of the material. The evaluation and diagnosis are written in paragraph form, and contain the essential findings from the examination. The prognosis and plan of care are clearly stated, with support from evidence-based research.

What I found most impressive about each case study was the intervention section, which is both specific and expansive. The rationale behind the chosen interventions is supported by reliable and valid research. The therapeutic exercise interventions focus on balance, gait, flexibility, strength and aerobic conditioning. Functional interventions target re-integration into the school, work or community setting where applicable.

Many activities are provided for readers to use when designing a plan of care appropriate for their patients. The anticipated goals for each patient discussed are clearly presented, objective and measurable. Recommendations for reexamination and discharge are given based on the patient's status and functional achievements.

 In several of the chapters, tables and diagrams are used to complement the background information of the topic. In chapter four, which discusses Pattern D and CVA, a wonderful table is provided reviewing the arteries most commonly occluded in conjunction with the related physical manifestations. In chapter six, whose topic is peripheral nerve injury (Pattern F), the material is enhanced with an abundance of pictures and tables.

There is a table listing the muscles innervated by the facial nerve and their subsequent actions. There are also several diagrams of the components and neurophysiology of the vestibular system. This chapter contains the most case studies, ranging from median and facial nerve dysfunction to vestibular disorders, disuse disequilibrium, Meniere's disease, and benign paroxysmal positional vertigo (BPPV). I particularly liked the case study on BPPV because the authors included a diagram and explicit instructions on performing the Dix-Hallpike and canalith repositioning maneuver as a treatment technique.

Each chapter ends with a comprehensive list of references supporting the information in the chapters. Some chapters have a reference list with more than 150 articles researched. The authors are truly promoting a culture of evidence-based practice for the physical therapy professional.

With the amount of knowledge, case studies and examples of treatment techniques this book offers, I would highly recommend it to any physical therapy professional at any experience level. This text can facilitate a better understanding and application of the Guide to Physical Therapist Practice when treating patients with neuromuscular deficits.

? Neuromuscular Essentials: Applying the Preferred Physical Therapist Practice Patterns, is a 320-page, soft-cover text priced at $58.95 and available from Slack Inc., 800-257-8290 or www.slackbooks.com

Shannon Bushong works for Christiana Care Health System in Delaware.


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