Orthotics and Prosthetics in Rehabilitation Edited by Michelle M. Lusardi, PhD, and Caroline C. Nielsen, PhD Butterworth-Heinemann, Woburn, MA, 2000, 720 pages, $99.00
The publication of a new textbook for orthotics and prosthetics is a rare and unusual event. The appearance of a text on this subject written specifically for physical and occupational therapists is even more unusual. Orthotics and Prosthetics in Rehabilitation is a comprehensive look at orthotics and prosthetics that is designed primarily for use by physical therapy students.
Editors Michelle M. Lusardi, PhD, PT, and Caroline C. Nielsen, PhD, recruited more than two dozen individuals to write the 31 chapters that comprise the book. Many of the authors are orthotists and prosthetists, some are physical and occupational therapists, some are physicians, and others are podiatrists. Each chapter is written by the appropriate specialist(s) in the topic covered.
The book is divided into three sections. The first, “Building Baseline Knowledge,” consists of four chapters, starting with an overview of the health care team approach written by Nielson. Her philosophy and, perhaps, the leitmotif of the book are revealed when she writes: “Key attitudes for the collaborating health professional include (1) understanding the functional roles of each health care discipline within the team and (2) establishing respect and value for each discipline’s input in the decision-making process of the health team.” This statement sets the tone for the rest of the book. Here is a place to share knowledge, without fear of encroachment, simply for the improvement of all involved.
In Section I, there is an excellent chapter entitled “Clinical Assessment of Pathologic Gait.” Its emphasis is on functional assessment. Edmond Ayyappa, CPO, and Olfat Mohamed, PhD, PT, conclude the chapter with case studies, followed by the impact on gait of the appropriate orthotic treatment. This approach makes a normally esoteric topic very practical. Also of note in this section is Chapter 4, “Exercise, Energy Cost, and Aging in Orthotic and Prosthetic Rehabilitation,” which clearly details the age-related debilitation of the cardiopulmonary system and its importance in rehabilitation.
Section II is a stepwise look at orthotics, literally from the ground up. There is an entire chapter concentrating on the importance of appropriate footwear, which is the foundation of any lower limb orthotic treatment. Chapters are arranged in sequential order, building upon the knowledge gained in the previous chapters. At the end of the section, Sheila A. MacGregor, OTR, LMS, provides a wonderful chapter, “Principles of Splinting of the Hand.” In it, she provides case studies to reinforce her concepts.
Section III discusses prosthetics. Organized from the most distal to the most proximal application, each chapter essentially crosses another joint and covers componentry not previously discussed. Rather than list a multitude of specific products, the authors classify different components and provide examples of each. The practicing prosthetists authoring these chapters ensure that the fitting procedures and components covered are the most up to date. In addition, a chapter on training and rehabilitation follows each of the prosthetic chapters in this section. The treatment outlined is very pragmatic and relies on closed-chain exercises to address the anatomical deficiency of the amputation level.
Each chapter of this book is comprehensive. There is no need for the reader to search through different chapters to find the material pertinent to an individual case. Anatomy, orthotic design with discussion of rationale, and anticipated results are covered in a stepwise fashion. In the chapters on therapy, this information is applied to treating the patient. Furthermore, the book’s medical illustrations are wonderful, each chapter’s bibliography is extensive, and the index is clear and easy to use.
The authors for each chapter were assigned a topic and a required length, but were given very few other guidelines. As a result, some chapters are much more advanced than others are and some have a significant overlap. Much of the chapter entitled “Transtibial Prosthetics” is repeated in the following chapter, “Transtibial Prosthetic Training and Rehabilitation.” This may be an inadvertent reaffirmation of the “team” concept, because the former was written by a certified prosthetist whereas a pair of physical therapists wrote the latter. Although the material is a bit redundant, the difference in perspectives is interesting.
Not all of the book’s photographs are properly edited. One picture shows a right transfemoral residual limb donning a left transfemoral prosthesis. The example of a rigid removable dressing has a very bumpy plaster application. However, these instances are more the exception than the rule, because most of the book’s photographs are excellent.
Because the emphasis of the book is on collaboration of the health care team, this is not a resource for therapists who are in the market to make their own orthoses and prostheses. It is instead for those who wish to understand the complexities of orthotics and prosthetics to better interface with the devices and the individuals wearing them. Just as physical and occupational therapists improve the quality of care given to their patients by broadening their knowledge base, perhaps orthotists and prosthetists could do the same by learning more about the entire rehabilitation process.