Neurological Rehabilitation: Optimizing Motor Performance

Abstract

This second edition of Neurological Rehabilitation: Optimizing Motor Performance provides a practical, task-oriented approach to rehabilitation for clients with neurological conditions, emphasizing active participation by clients and providing details of exercises and training to challenge them and help them regain the strength and endurance needed for independent living. In the new edition, authors Janet Carr and Roberta Shepherd have included updated scientific evidence as well as input from colleagues whose research and clinical expertise are also in this area of practice. Neurological Rehabilitation is also innovative in discussing the need to expand rehabilitation to increase opportunities for practice by including semi-supervised groups and circuit training in addition to traditional one-to-one interventions. The book is divided into three parts. Chapters 1–3 provide a foundation for understanding the role of neuro-rehabilitation in recovery. Chapter 1 reviews plasticity in the brain and the role of practice and challenge in brain reorganization; chapter 2 builds on this by discussing task-specific practice, the principles of motor learning, and clinical applications of these principles in neuro-rehabilitation. Chapter 3 provides an overview of measurement tools commonly used in neuro-rehabilitation. Part 2 devotes one chapter to each of the following specific actions required for independent living: standing up and sitting down, walking, reaching and manipulation, and balancing. Each chapter describes the action and the biomechanical factors, the motor dysfunction that occurs following neurological injury, and practical methods for training, focusing on repetitive task-oriented training, functional strength training of task-related muscles, and maximizing skills with practice and variety. The information on training is applicable to patient care, but because it focuses on clients who are able to perform the action, there is less guidance for working with those who are unable to do so, or who need to work on other tasks such as getting out of bed. Part 3 covers lesions to the motor and sensory–perceptual systems and includes detailed chapters on stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. Each chapter discusses the pathology of the lesion or condition, resulting clinical features, training, and specific assessments. The recommended management consistently includes specific exercises and task-specific and aerobic training. Throughout, Carr and Shepherd also provide information on supplementary methods for rehabilitation, including mental practice, orthosis, electrostimulation, and computerized aids, and discuss the evidence-based benefits of including these methods in management strategies. Photos of exercises, clients, and clinicians working with clients complement the text and are helpful for applying the information clinically. Neurological Rehabilitation: Optimizing Motor Performance is an excellent book for a practical, task-oriented approach to neuro-rehabilitation, and I would recommend it as one of the key resources for working with clients with neurological conditions. However, additional resources may also be useful, since this book focuses on the task-oriented approach and offers little information or evidence on other approaches. Because of its rehabilitation focus, Neurological Rehabilitation will be most beneficial to physical therapy students, new graduates and experienced clinicians who work in neuro-rehabilitation, but other health care professionals and physical therapists in other settings may also find it helpful for the detailed information it provides on neurological injury and recovery. Overall, Neurological Rehabilitation balances evidence with clinical application, provides a foundation of knowledge for neuro-rehabilitation as well as methods for promoting motor learning and plasticity, and encourages readers to think about changing the delivery of therapy to enhance learning and recovery.