B o o k  R e v i e w s

N eurom usculoskeletal Exam in atio n a n d  A ssessm en t
Nicola J Petty and Ann P Moore, Churchill & Livingstone, Edinburgh, 1998

T his book w ill be o f great value for both undergraduates and post graduate 
physiotherapists. It is a most comprehen­
sive book on examinations and assess­
ments', and has put together the works of 
a number o f clinical and manipulative 
therapists who have gained recognition 
for their outstanding w ork such as Butler, 
Cyriax, Edwards, Elvey, Grieve, Jull, 
Kaltenborn, McConnell, McKenzie, M ait­
land, Mulligan, Richardson, Sahrmann 
and Stoddard.

All aspects o f assessments are covered 
with special attention given to the ques­

tion and answer technique. Each area of 
examination is a chapter on its own and 
includes:
1.The possible causes o f pain a n d / 

o r limitations.
2 .The subjective exam ination includes 

the following body chart, behaviour of 
symptoms, special questions, history of 
the present condition, past medical 
history, social and fam ily history and 
plan o f the physical examination.

3 .The physical examination contains the 
following: observation, joint tests, muscle 
tests, special tests, functional ability,

palpation and passive accessory inter- 
vertebral movements.

The book is user friendly and well written.
Each examination test is demonstrated 

by an excellent photograph or drawing.
This is the kind of book that should be 

available in busy physiotherapy practices 
and departments to be used regularly as it 
w ill enhance the assessment skills o f the 
user thus making the treatment relevant 
and of a high standard.

RENATE VAN RENSBURG

S teps to  Fo llo w
The C o m p r e h e n siv e T reatm en t o f  Pa tien ts w ith H em ipleg ia

Patricia M Davies, Berlin, Springer-Verlag, 2000

The long awaited second edition o f Steps to Follow has been expanded by 
more than 200 pages and 248 additional 
photographs and is extensively references. 
W hilst retaining the much appreciated 
form at of the previous edition, this new 
edition has been completely revised and 
includes many expanded chapters and 
some new ones.

In her preface, the author reflects on 
the validity (or lack thereof) of many cur­
rent assumptions about the rehabilitation 
process in hemiplegia, and sets the tone 
for a book, which is both thoughtful and 
challenging. The author's concern regard­
ing the quality o f life for persons with 
hemiplegia is made clear from the first 
chapter, w hich stresses how disturbed 
perception interferes with not only posture 
and movement, but also many other 
aspects of effectual behaviour and learn­
ing. Integration o f activity in function is 
emphasises from the beginning and the 
section on therapeutic guiding has been 
expanded in order to show how suitable 
task selection, coupled with manual gui­
dance which enables the patient to explore 
the problem-solve, can enhance the ability 
to interact with the environment.

The chapter on norm al movement 
sequences and balance reactions has also 
been expanded to include a section on 
task-oriented arm and hand movements.

In chapter 3, on abnormal movement 
patterns in hemiplegia, the section on 
abnorm al tone has been re-written to 
explore more recent theories on the nature 
of tone. Mention is made here o f abnormal 
tension in the nervous system, which is dis­

cussed in detail later in the book. This is 
also mentioned in the following chapter on 
assessment. The excellent chapters on treat­
ment in the acute phase, on normalising 
tone and teaching selective movement, and 
on retraining balance reactions have 
been enhanced by some additional activi­
ties and several new photographs, as well 
as by discussion on more controversial 
issues. In particular, discussion on the use 
of a rolled bandage under the toes has 
been expanded to include the biomecha­
nics o f the foot during stance and walking, 
and should dispel any concerns about this 
helpful aid to treatment. A t the end o f each 
chapter the section on considerations has 
been re-written to include discussion based 
upon recent publications. There are new 
sections on retraining selective flexion of 
the arm and hand and on using specific 
therapeutic activities in the chapter on 
encouraging the return of activity in the 
arm and hand.

The chapter on re-educating functional 
w alking has been extensively re-written, 
w ith more in-depth problem -analysis. 
New ideas on orthoses have also been 
included. The chapters on some activities 
of daily living and on mat activities remain 
relatively unchanged but the former now 
includes a useful section on putting on a 
brassiere -  something that many o f our 
female patients find difficult to master.

M aterial on the shoulder and the hand 
has been extensively revised, within-depth 
discussion o f the two as separate entities 
and with explanation of the role which 
adverse neural tension may play.

In chapter on the pusher syndrome there

is a new section on predisposing factors 
and several new ideas for treatment.

One of the most noticeable and valuable 
additions to the book is the completely 
new 40-page chapter on mobilisation of 
the nervous system. This section explains 
the biomechanics and pathophysiology of 
the nervous system and shows in detail 
how this knowledge can be incorporated in 
evaluation of the patient with hemiplegia, 
and how mobilisation of the nervous system 
can be integrated into treatment. This new 
information is also included in the greatly 
enlarged chapter on m aintaining and 
improving mobility at home.

The layout o f the new edition is modern 
and attractive and makes for easy refe­
rence. The w ay in which it is written and 
referenced makes it suitable for both expe­
rienced therapists and students. It is an 
essential purchase for all those therapists 
(physiotherapy, occupational therapy and 
speech) who are involved in the rehabilita­
tion o f adults with neurological disorders. 
The many doctors, nurses and relatives o f 
patients, who derived so much insight as 
well as practical ideas from the first edition, 
w ill find the new edition even more helpful.

The first edition o f this book was pu­
blished in nine languages and sold many 
hundreds o f thousands o f copies. This sec­
ond edition looks set to achieve new records.

Finally -  all to often readers skip the 
forw ard to professional book. The forwards 
by Professor Jurg Kesselring may not be 
the easiest of reading, but it is well worth 
the effort.

SHEENA IRWIN-CARRUTHERS

40 SA J o u r n a l o f  P h y s io th e ra p y  2001 V o l  57 No 1

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