Geriatric Rehabilitation Manual, ed 2

In the preface to the second edition of Geriatric Rehabilitation Manual, the editors state that "given the constraints of time and health care payment systems, one must have easily accessible concise, and yet comprehensive, information," suggesting that this manual will meet that expectation. And, as the 11 units of the manual unfold, it is clear that the editors have succeeded in providing a creative and informative text that can serve as a reference to any student or clinician in the geriatric workplace.

This is a comprehensive manual with an impressive list of contributors. The manual is divided into 11 units, with each unit containing between 3 and 14 thorough and concise chapters. Each chapter begins with an outline of the chapter's content, and subtitles used in the outline are bolded throughout the chapter. This feature, plus a very comprehensive index, makes for easy maneuvering through the book.

Unit 1, "Anatomical and Physiologic Considerations," consists of 14 chapters covering the major physiological systems of the body-bone, heart, and nervous system-and ending with chapters on pharmacology, laboratory assessment, and imaging. The final chapter in this unit, "Imaging," is a new and excellent addition to this second edition. It discusses the advantages and disadvantages of various imaging modalities and summarizes these issues in a table. There are multiple blackand- white images, including radiograph, computed tomography, and ultrasound, all with clear explanations and arrows on the images to clarify and support the text. The use of images is applied throughout the manual.

Unit 2, "Musculoskeletal Disorders," includes 13 chapters on subjects such as posture; postpolio syndrome; osteoporosis; and the shoulder, hip, and knee. The chapter on posture utilizes photographs particularly well, along with good use of boxes that provide information on age-related postural changes and clinical interventions. Chapter 21, "The Shoulder," includes multiple boxes, containing information such as "problems and interventions for degenerative rotator cuff," and "expected passive range of motion at 12 months post shoulder arthroplasty." Boxes in the chapter on total hip arthroplasty list postoperative concerns and home care instructions for hip patients.

Unit 3,"Neuromuscular and Neurological Disorders," contains 8 chapters on trauma, stroke, multiple sclerosis, and Parkinson disease. The neurological trauma chapter includes tables of the Glasgow Coma Scale and Rancho Los Amigos levels of cognitive function, for quick reference. The chapter on rehabilitation after stroke gives a very clear summary of the different protocols in use, such as Bobath, proprioceptive neuromuscular facilitation, Brunnström, or Rood, and provides research to support or challenge each protocol's effectiveness. This section strongly emphasizes the inclusion of the caregivers in treatment plans, as well as focusing on the goals of the patient and family.

Unit 4 contains 5 chapters covering different neoplasms: brain, breast, gastric, skin, and prostate. Units 5 and 6 are titled "Cardiopulmonary Disease" and "Blood Vessel Changes, Circulatory and Skin Disorders," respectively. Unit 5 opens with a chapter on exercise consideration for aging adults, which contains a number of useful tables and boxes that provide further information and guidelines on calculating heart rate, perceived exertion, and terminating exercise. This chapter also illustrates another strength of the manual: the reader is referred to other chapters for related information in order to avoid repetition. Chapter 50, "Wound Management," in unit 6, is another fine example of how useful this manual can be to the clinician, especially one relatively new to the geriatric field. The chapter includes wound classifications and offers alternative wound classification; suggests what a physical therapist should be aware of; and offers a comprehensive, 3-page sample evaluation form. There are clear black-and-white photographs to assist with wound identifi cation, plus 2 boxes of therapeutic intervention and treatment suggestions.

Unit 7, "Aging and the Pathological Sensorium," contains 3 chapters on vision changes, the changes in the aging ear, and communication considerations. Unit 8, "Specific Problems," has 12 chapters that cover topics such as incontinence, dysphagia, dizziness, balance, overweight and obesity, and pain evaluation. The chapter on iatrogenesis, which includes an excellent section on the immediate impact of immobility on the elderly, and the chapter on hormone replacement therapy (HRT), which provides a useful summary of the history surrounding the use of HRT, also are worth mentioning.

Unit 9, "Special Physical Therapeutic Intervention Techniques," includes gait training, orthotics and prosthetics, aquatic therapy, and a good chapter on conservative interventions for pain control that summarizes the effectiveness of many of the electrotherapeutic and thermal interventions used by physical therapists. Also in this unit is a chapter on complementary therapies specifically for the aging patient, with the emphasis on complementary- not alternative-therapy supporting traditional physical therapy intervention.

Unit 10, "Social and Government Implications, Ethics and Dying," approaches some of the very difficult topics surrounding geriatric rehabilitation. These 5 chapters include a comprehensive and clear discussion of the ethics surrounding care for the geriatric patient. The chapters emphasize the issues surrounding the practitioner when dealing with the complexity and demands of reimbursement with the geriatric patient, along with the legal considerations and generational conflict. Lastly, unit 11, "The Rehabilitation Team," discusses the caregivers, nurses, physical therapists, occupational therapists, and social services.

Geriatric Rehabilitation Manual is clearly designed for physical therapist students and clinicians. The manual is comprehensive, covering a vast amount of material; yet the authors of the individual chapters have managed to remain concise. As a result, this manual is a useful reference for a professional, an excellent guide to a student or young clinician, and a good starting refresher course for a future geriatric clinical specialist candidate. Each chapter has excellent evidence-based support, and each chapter ends with its list of references, again making this a very user-friendly manual. There is inevitably some overlap in the chapters, but this usually is minimal; references to other chapters avoid too much repetition.

This is a book that would prove to be a very useful addition to any clinical library and an excellent reference source for both students and clinicians. The quality of the contributors and the organized format combine to make the manual a pleasure to read, and the references offer useful material for further reading and research.

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