Appraisal

Media

A classic, practical guide for physiotherapists

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The 1998 rst edition of Neurological Rehabilitation
was a breath of fresh air in its approach which utilised a
biomechanical and motor learning framework. The structure
of this second edition is fairly similar to the original version.
The book is a practical guide primarily for physiotherapists,
and may be of interest to physiotherapy students as well as
some other allied health professionals. This revision adds
contributions from ve highly regarded physiotherapy
authors: Phu Hoang, Julie Bernhardt, Anne Moseley,
Leanne Hassett, and Colleen Canning. The literature has
been updated, and there is a welcome use of literature from
systematic reviews and meta-analyses. One of the most
visible changes has been the addition of many more pictures
with patients (and when relevant, therapists). The pictures
are highly illustrative, demonstrating various techniques and
concepts, and provide ample therapeutic ideas.
The rst two sections provide general content on movement,
and exercise and training, while the third and nal section
focuses on individual conditions (multiple sclerosis,
stroke, traumatic brain injury, Parkinsons disease, etc).
There is also an overview of neurorehabilitation outcome
measures in the rst section. It is difcult to ascertain the
value of these brief outcome measure descriptions when
there are now several outstanding web-based platforms
that offer free, up-to-date and comprehensive information
on neurorehabilitation outcome measures (eg, EvidenceBased Review of Stroke Rehabilitation, ebrsr.com;
StrokEngineAssess, strokengine.ca/assess; Spinal Cord
Injury Rehabilitation Evidence, SCIREProject.com; Rehab
Measures Database, rehabmeasures.org; and EvidenceBased Review of Acquired Brain Injury, www.erabi.com).
However, for an entry-level clinician, this section may be
useful as an introduction to outcome measures, although
more experienced clinicians would likely want more details
to enhance their utility of the tools (eg, the amount of
change needed to be clinically important).
The largest expansion in the second section has been the
section on Task-related exercise and training. There are
valuable additions on the topic of muscle strengthening and
cardiorespiratory training and this reects the exponential
growth of clinical research in these areas over the last
decade. In addition, there are new sections illustrating
applications of recent technology (computer-aided therapy,
virtual reality, robotic and electromechanical training).
There is also a much expanded section on forced use of the
upper extremities and bimanual training. Clinicians will
appreciate the handy summary boxes which recap different
task-specic training protocols. There is a strong focus on
stroke in this section with much of the evidence supported
by studies utilizing stroke populations. However, this can
be problematic when you move into the stroke chapter of

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the third section, because you start to wonder if you have

already read some of the material. Some additions resulted
in a few minor editing problems (eg, the non-weight
bearing strength training component discusses sit-to-stand
concepts).
The third and nal section presents seven chapters on
different neurological conditions. Each chapter reviews the
pathophysiology, signs, and symptoms, clinical assessments
and relevant physiotherapy treatments. While there are a
few instances where clinical practice guidelines (CPGs) are
mentioned, I would have liked to see more integration of
CPGs as clinicians often struggle to implement information
from CPGs into their everyday practice. However, in
general, these disease-specic chapters provide practical
and concise information, and it is very helpful to have
this information (from pathophysiology to treatment)
all in one place. While there is a strong focus on motor
and tness training, these chapters do make the reader
consider other important aspects (eg, sexual health, role of
family, discharge planning, patient education, community
reintegration, communication, cognition, behaviour, etc).
There are some gaps. I was disappointed with the limited
information on electrical stimulation as the Australian, UK,
Canadian, and American guidelines all recommend their
use for specic upper or lower extremity conditions after
stroke, and some guidelines now also recommend their
application for other conditions such as multiple sclerosis.
It would have been benecial to provide some sample
protocols of electrical stimulation (electrode placement and
stimulation parameters, examples of functional electrical
stimulation devices) as was presented with the sections on
exercise prescription. Another gap was the limited content
addressing the incidence of falls and fractures. There was
very practical and useful information on improving balance
function, but very little discussion on the multidimensional
causes of falls (eg, medications, incontinence, abrupt changes
in blood pressure) and treatments for different domains (eg,
hip protectors, modifying the home environment) which
would help clinicians think broadly about the complex
topic of fall and fracture prevention. The authors did add
fear of falling and balance condence to their measurement
section which recognises the importance of this construct
that has emerged over the last decade.
In summary, I would call this edition more of an update,
rather than a major revision; however, this second edition
remains a classic, practical guide for physiotherapists.
Janice Eng
Professor, Department of Physical Therapy
University of British Columbia, Canada

Journal of Physiotherapy 2012 Vol. 58 Australian Physiotherapy Association 2012