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Therapeutic Exercise: Treatment Planning for Progression

Huber FE, Wells CL. St Louis, MO 63146, Saunders, 2006, paperback (with DVD), 400 pp, illus, ISBN: 072164077X; $49.95.

The book contains 7 chapters. Chapter 1 starts with an introduction to general concepts of therapeutic exercise. This chapter also discusses the disablement model, documentation and writing goals, and patient education. A nice feature of the second chapter, "Addressing Functional Limitations and Disability With Therapeutic Exercise," is the analysis of basic functional movement patterns geared for the beginning student.

The next 5 chapters address specific impairments commonly treated with therapeutic exercise. Chapter 3 covers principles of range of motion and stretching. Basic stretching techniques are discussed and substantiated by a few research articles. I was surprised that there was no mention of active/dynamic stretching, because this technique has been the topic of several recent articles in the physical therapy literature.

Chapter 4 is devoted to the topic of strengthening. The beginning of the chapter presents the basic physiology of muscle strengthening, including muscle types. Modes of resistive exercise and exercise prescription are provided. The chapter ends with a section on special considerations for resistive exercises.

The fifth chapter on balance is complete and includes assessment and treatment of balance impairments. This chapter contains a chart of medications that affect balance, a useful tool for the physical therapist student. The sixth chapter covers coordination and proprioception. Nonequilibrium coordination is addressed in the first half, with a discussion of normal coordination, followed by assessment and intervention. The second half of the chapter covers proprioception. Sensory receptors are described, along with disorders, examination, and intervention of proprioception. The seventh and final chapter focuses on endurance impairments. I found this chapter to be comprehensive, with topics ranging from cardiovascular physiology to aerobic exercise training and prescription.

The text is supplemented with 5 appendixes on constructing concept maps, visual problem solving, lab exercises, "stop and think" questions and answers, and study questions and answers. As an instructor, I can see the usefulness of these tools as an adjunct to teaching materials. A glossary is also provided at the end of the appendixes.

Overall, the book contains essential information for the professional physical therapist student. The text's material is consistent with the Guide to Physical Therapist Practice. However, I was disappointed by the limited attention paid to topics such as aquatics, posture, and muscle imbalances. In addition, I would have liked to see a more comprehensive list of research articles included with each chapter to emphasize evidence-based practice.

Perhaps the most useful part of the text is the 3 ongoing cases that are revisited in each chapter. These cases are introduced in the first chapter, and exercise progression is added in each subsequent chapter. The cases are distinctly different, covering different points in the lifespan, physiological system, and stage of healing. Each chapter also includes 1 or 2 patient vignettes. "Stop and think" boxes that alert the reader to important concepts are dispersed throughout each chapter.

Every chapter begins with a list of learning objectives, a chapter outline, and keywords and ends with study questions. The chapters are supported by figures and tables. At first glance, the layout of the book is confusing due to the mixture of patient vignettes, cases, and "stop and think" boxes. After reading through the first couple of chapters, however, I adjusted to the format and welcomed these added features.

A DVD is included with video clips of the text's figures. The DVD is intended to provide students a medium to observe and critique exercise technique. I believe that the clips fall short of this goal as an independent learning tool. For example, the video clip of plyometric exercise mentions nothing about technique or progression.

The book is applicable to the professional physical therapist student and could be used across the physical therapy curriculum. The exercise concepts are presented at a basic level, and the experienced clinician would find the material too elementary.

Janice Loudon

J Loudon, PT, PhD, SCS, ATC, is Associate Professor, Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, Kan

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