This neurorehabilitation textbook was born from the need for a textbook that is built around the International Classification of Function (ICF) framework, which drives the way therapists make clinical decisions. This book for physical therapists and occupational therapists is unique in that it is organized by the constructs of body structure/function and functional activity rather than specific medical diagnoses. The book also focuses on patient management from an evidence-based perspective, with application across the lifespan because neuromuscular impairments can affect patients similarly, regardless of age.
With contributions from approximately 60 educators and professionals affiliated with the APTA Academies of Neurologic Physical Therapy, Pediatric Physical Therapy, and Geriatric Physical Therapy; occupational therapy faculty; and authors from other countries, the book represents the professional lifework of the textbook editors. Developed over a decade, this text has been a monumental task of scholarly synthesis and coordination of the conceptualizing, preparing, writing, editing, and illustrating that led to the final product; it could not have been completed without the significant contributions of many individuals. Each chapter author integrated available evidence with knowledge, understanding, energy, and enthusiasm to make this textbook an academic endeavor. The authors synthesized the most recent rehabilitation evidence for students, faculty, and clinicians to support clinical decision-making while maintaining a focus on practical clinical application, and will also be useful for those preparing for specialization.
Despite the many challenges that delayed publication, including publisher transition, disruption from a major hurricane, battles with cancer, and loving our parents through end-of-life care, the necessary revisions and updates over this period propelled the textbook to a stronger finish than could otherwise have been possible.
Two important conceptual models, (1) the APTA’s Patient/Client Management Model and (2) the World Health Organization’s (WHO’s) ICF, are central throughout the text. The sections of the book are organized using the APTA Patient/Client Management Model (with sections on decisionmaking, examination/evaluation, intervention principles, and specific interventions/plan of care). The chapters of the examination and intervention sections are structured by WHO ICF constructs (with some chapters focusing on underlying impairments of body structure/body function, and other chapters focusing on functional activity limitations and participation). Because we think about and design patient care in this way—not simply providing intervention based on the medical diagnosis—we have similarly organized the book to assist in teaching students. This text organization provides a sound basis for selecting each component of patient examination and planning interventions that are based on the examination results. It also eliminates redundancy, which is inherent in chapters organized by medical diagnoses. For example, in other books, the information on balance intervention may be found primarily in the brain injury chapter, but similar balance interventions are also essential in rehabilitation for individuals with stroke, multiple sclerosis, and other neurologic diagnoses. The book is also unique in its application of neuromuscular examination and intervention techniques across the lifespan, from pediatrics to adulthood and geriatrics. And equally important, key content is always built upon the available evidence.
Section I chapters review the basis and process for making sound, patient-centered clinical decisions when managing patients with neuromuscular disorders, including the Hypothesisoriented Algorithm for Clinicians (HOAC). Section II addresses examination/evaluation processes for specific impairments and functional activities/limitations common to neuromuscular disorders. Section III presents general therapeutic intervention concepts, principles, and approaches, as well as topics pertinent in all patients with neuromuscular disorders, such as health promotion/prevention and assistive/adaptive equipment. Each chapter of Section IV focuses on interventions for a specific impairment, presenting a variety of methods to specifically address that impairment. We can refer to these impairmentbased interventions as “preparatory” interventions because they are often applied early in rehabilitation to directly improve the known impairments that underlie and contribute to functional deficits. However, these impairment-based interventions are aimed ultimately at enhancing the patient’s functional skill/activity and participation. Each chapter in Section V focuses on task-specific functional interventions to directly improve a specific functional skill/activity and participation of the patient.
The writing style is intentionally reader friendly, with use of direct active voice to explain any techniques or methods (e.g., “Place your hands on...”) for clear instruction, while avoiding passive voice whenever possible. In addition to the rationale for specific applications, each chapter provides specific methods and techniques with stepwise instructions that “you” can apply in clinical practice. Chapters include “Patient Application” case studies, introduced early in the chapter, that are pertinent to the content and are progressively developed throughout the chapter. Each “Patient Application” case feature is followed by “Contemplate Clinical Decisions” questions to facilitate thinking about key concepts in the case. The case study and questions serve as a reference point for considering the impairment or functional limitation in the context of the person with a disability and both current and future implications for the individual and the family.
Each chapter contains “Think About It” boxes with probing questions to guide the reader’s thinking or concise “nuggets” or “pearls” to highlight essential information. The Examination and Intervention chapters include references to evidence-based “Focus on Evidence” (FOE) tables summarizing the more important studies for that topic. The FOE tables are available in the online supplemental material.
In some intervention chapters, more comprehensive case studies are included in the online supplemental material. These case studies address the more complex clinical decisionmaking required for patients with multiple impairments and comorbidities. Guiding questions lead the reader through a process of developing a patient-centered, evidence-based, comprehensive plan for evaluation and intervention of the person with a neuromuscular disorder. In addition, the instructor has access to supplemental material online, including a test bank of multiple choice questions with answer key, an Instructor’s Guide with answers to or discussions about the chapter case questions, answers to the “Let’s Review” exercises, and suggested in-class learning activities.
The scientific literature guiding rehabilitation is immense and is growing daily. As a result, knowledge of all aspects of neurorehabilitation is beyond the capacity of any individual; so this textbook can serve as a long-term resource for clinicians. Even as this first edition debuts, the second edition is germinating in the authors’ minds as new information becomes available to support clinical practice. We welcome any suggestions for improvement or corrections to the content moving forward. Here’s to providing the best possible, most effective therapeutic care to restore movement, function and meaning to life!