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. 2009 Feb;61(1):47–50. doi: 10.3138/physio.61.1.47

Book Reviews

PMCID: PMC2788320
Physiother Can. 2009 Feb;61(1):47–48.

Physical Therapy Ethics

Christine Carpenter 1
Physical Therapy Ethics. Donald L. Gabard, Mike W. Martin. Philadelphia:  F.A. Davis Company;  2003 ISBN-13  978-0-8036-1046-0 ISBN-10  0-8036-1046-7 260 p.  US $38.95

Despite growing recognition of the increasingly complex and autonomous nature of physical therapy practice, limited attention has been given in the physical therapy literature or in professional education programs to an analysis of ethical issues germane to the profession. The study of health care ethics has to date been primarily dominated by the “big ticket” issues arising from medical and nursing practice in acute-care settings. The moral significance of physical therapists' practice and the ethical dimensions of rehabilitation service provision have remained largely neglected. Health care ethics combines the study of philosophical ethics, which is concerned with what people ought to do and how they ought to conduct themselves (normative or prescriptive ethics), with the study of human moral behaviour, which explores the influence of social, cultural, and contextual factors on how people act in certain situations.

Physical Therapy Ethics is one of the few available books that specifically integrates the practical issues and problems experienced by physical therapists with philosophical ethics. The authors—an associate professor of physical therapy and a professor of philosophy—have effectively collaborated in writing a book that is relevant, accessible to the reader, and informative. The authors' stated intent is to provide tools for physical therapy clinicians, researchers, and students to assist their decision making and reflection on the day-to-day ethical dilemmas and moral conflicts arising from their practice. This intent is fully realized in the content of this very well written book.

Each of the 11 chapters focuses on a key value—for example, respect for autonomy (Chapter 3) or honesty (Chapter 7)—combined with related topics in which the value plays a major role, such as informed consent, confidentiality, or conflict of interest. The first two chapters make a cogent argument for the importance of including the study of ethics in physical therapy education programs and the contribution it can make to moral development, professional behaviour, and ethical decision making in practice. The authors provide a clear, concise, and balanced analysis of the most influential ethical theories—rights and duty ethics, act and rule utilitarianism, virtue and religious ethics, and pragmatism. These theories are revisited and reinforced in subsequent chapters as the authors introduce and critique a range of topics such as resource allocation and scientific integrity. These chapters represent an excellent introduction to normative ethical theory, and the authors are to be congratulated on effectively condensing this seminal material without losing its impact. I particularly appreciated the chapter entitled “Respect for Persons and Diversity,” which explores the complexities of cultural diversity, minorities, and sensitivity that are integral to ethical issues as experienced in health care but are rarely addressed in traditional health care ethics texts. On occasion, the authors make useful comparisons among the health care systems of the United States, Canada, and the United Kingdom, but they are writing primarily from an American perspective. As a result, the statistics and legal implications discussed in Chapter 4 (related to family violence and to reporting child and elder abuse) and in Chapter 7 (which focuses on systemic conflict with managed-care provision and physician referral) are not as relevant to a wider international readership. Chapter 8, entitled “Integrity and Wrongdoing,” explores important issues related to professional behaviour that arise in practice when professionals exhibit poor judgement even though it is reasonably clear what is required of them and includes the often unacknowledged problem of sexual harassment between therapists and patients. Discussion of these pervasive problems is disappointingly superficial and fails to address the complexities that these situations customarily present. However, these are minor criticisms in light of the overall quality of this book.

Several strategies are consistently employed that make the content accessible as well as stimulating and challenging. Throughout the book, the authors clearly define the terms they are using and provide relevant and very interesting explanatory examples, primarily in the form of cases and references to famous real-life situations. The use of cases specifically addressing appropriate and timely issues in physical therapy is a particular strength of this book. Each chapter includes a carefully selected and informative list of references. At the end of each chapter, the authors also pose some thought-provoking discussion questions to assist the conscientious reader in reviewing the chapter's content and the ethical dilemmas presented.

It is a pleasure to recommend this book for undergraduate and graduate physical therapy students and practising clinicians who wish to engage in an exploration of health care ethics, and as a useful text for faculty members who are planning and implementing ethics courses in physical therapy education programs.

Physiother Can. 2009 Feb;61(1):48.

Head, Heart and Hands: The Story of Physiotherapy in Canada

Frances Jamieson 1
Head, Heart and Hands: The Story of Physiotherapy in Canada. Joan Cleather. Toronto:  Canadian Physiotherapy Association;  1995. http://www.physiotherapy.ca ISBN-10  0-9698122-1-3 227 p., photos  CAD $40.00

In the summer of 2005 I read Harry Potter and the Half-Blood Prince and also read Head, Heart and Hands: The Story of Physiotherapy in Canada by Joan Cleather. I recommend this book (indeed, both books!) to all physiotherapists. Head, Heart and Hands was written and published to celebrate the CPA's 75th anniversary in 1995, and I am ashamed to say that I have always meant to read it. The author is a graduate of McGill University and was the editor of Physiotherapy Canada from 1967 to 1986. In that role she was at the forefront in witnessing the energy, enthusiasm, and commitment of those physiotherapists who, mostly volunteers, building on the work of those who had gone before, gave of their time. They served on the board, exam committees, CPA committees that struggled for the recognition of physiotherapy as a separate health care provider, and committees looking at specialization within the profession, regulation and protection of the public, future health care issues, development of a code of ethics, and supporting private practice. They also represented members in local divisions and branches, set up the Physiotherapy Foundation of Canada, negotiated with governments and the Canadian Medical Association (CMA), and so on. It is truly an amazing story: in 85 years, we in Canada have moved from a 2-month training course as masseurs and providing exercise and rehabilitation to injured men returning from World War I and World War II to a university education and a scientific-based profession that is autonomous and to which the public has direct access.

The book is not a dry read, and it is not just a historical list of what changes occurred and how. The seven chapters have the major headings “Scope of Practice,” “Delivery of Physiotherapy Services,” “Physiotherapy Education in Canada,” “Research in Rehabilitation Science,” “The CPA,” “CPA Membership,” and “Trends in Treatment.” Each chapter describes history, development, and changes (up to 1995). Much of what I have taken for granted was created and developed by physiotherapists who had the vision and determination to pull the profession from being physician dominated (e.g., the CMA regulated the curriculum until the 1960s) to what we have today: a self-regulating profession to which the public has direct access. Most of the work to “persuade” governments and medical and university governing bodies to bring about these changes was done by physiotherapists themselves. Aside from the fact that this is such an inspiring story, I feel it is our duty to know where we, as a profession, came from. Buy this book on line from the CPA Web site: at 227 pages, with great photos and some amusing anecdotes, it would make an excellent birthday, retirement, or graduation gift for that special physiotherapist in your life!

My only wish is that there would be an extra chapter or two added in a new update that would cover the last 15 years because so much has continued to happen within the profession. Our national exam is a model; we are now at master's entry-level education, and a doctoral degree is necessary for university instructors; our students graduate with solid research skills and knowledge; and those who have led the way in research have contributed to the scientific body of knowledge that has made the medical world and the public aware of the science, not just the art, of physiotherapy: we continue to use our heads, our hearts, and our hands. As I was first reading Head, Heart and Hands, the summer 2005 issue of Physiotherapy Canada arrived, and I was very pleased to read the guest editorial by Joan Cleather—I urge you all to read her book, reread the summer 2005 journal editorial written by Joan, and share both with your colleagues. Joan was also the 2008 Enid Graham Lecturer at the CPA Congress in Ottawa.

Do you know the CPA motto? Exercitio Manuque Medica—“By exercise and the healing hand.”

Physiother Can. 2009 Feb;61(1):49.

Strength Training for Women: Tailored Programs and Exercises for Optimal Results

Siobhan O'Donnell 1
Strength Training for Women: Tailored Programs and Exercises for Optimal Results. Lori Incledon. Champaign (IL):  Human Kinetics Books;  2005 ISBN-10  0-7360-5223-2 ISBN-13  978-0-7360-5223-8 232 p., illustrated  CAD $25.95

This attractive, soft-covered book delivers information to assist women in developing a tailored, individualized strength-training program in order to optimize their physical strength and achieve other fitness-related goals.

The author, a physical therapy assistant, athletic trainer, and strength/conditioning specialist, draws from her own knowledge and experience to provide women with a comprehensive guide to strengthening and balancing their bodies through weight training. With 102 exercise descriptions and six training programs, this book will empower women to improve their physical strength, take their routine to the next level, or learn new exercises to spice up their current weight-training program.

The specific topics addressed are organized into three main parts. Part 1 provides an overview of the evolution of women's strength training through the ages, exercise trends, the physical and psychological benefits of strength training, and strategies to increase metabolism. Part 2 highlights the main components of physical fitness; different types of strength training; nutrition tips on how to achieve your ideal weight; information on designing a strength program; ready-made routines for the beginner, intermediate, and advanced trainer; and a bone-building program. Finally, Part 3 provides descriptions of strength exercises by body part or region, the muscles primarily used during the exercises, and the effects of the exercises on the body, as well as sample training regimens for weightlifting, power lifting, and strong women competitions.

Almost all the strength training concepts and the warm-up, cool-down, and strength exercises illustrated would be endorsed by the Canadian physical therapist. In addition, the content provided allows readers to personalize the information to ensure an individualized, tailored program. The exercises are explained in a clear, concise manner, and the sample programs designed for beginner, intermediate, and advanced weight trainers are comprehensive. Furthermore, while many of the strength-related exercises included require the use of free weights, it is not necessary for individuals to perform the majority of these exercises within a gym setting.

The book is richly illustrated and contains a number of summary tables, all of which complement the text. The author uses straightforward language, and there is a deliberate absence of scientific jargon. Topics follow a logical sequence, and the information is presented in a format that enables the reader to review the book in its entirety or to select a chapter for review as the need arises. Specific features including an “exercise finder,” the glossary of terms, and the inclusion of the page number for each exercise listed in the ready-made exercise programs make this a user-friendly resource and will be appreciated by the reader.

Some limitations related to the content and organization of this book are worth mentioning. The information presented on the physical and psychological benefits of strength training is often based on opinion rather than on evidence. In addition, the chapter on nutrition lacks practical guidance on a balanced diet for general health and how it may differ during training and competition. Furthermore, some of the strength exercises would be very challenging for the beginner to execute with good form (e.g., the core strengthening exercises using a stability ball); therefore, the inclusion of staged exercises would have been helpful.

From an organizational perspective, there is some overlap in content between the two chapters in Part 1 pertaining to the physical and psychological benefits of strength training, which could have been consolidated. Furthermore, many of the exercises are given generic names without reference to the body part or region that they address (e.g., “concentration curl,” “wood cup,” “tire flip”), which makes it difficult for the reader to identify many of the exercises listed in the “exercise finder.”

Overall, Strength Training for Women: Tailored Programs and Exercises for Optimal Results is a valuable home resource for women on how to develop or enhance a strength-training program. For the clinician, this book would be a useful resource to loan or recommend to those female clients under their care who are ready to graduate to an independent weight-training program.

Physiother Can. 2009 Feb;61(1):50.

Joint Structure and Function: A Comprehensive Analysis, 4th Edition

Kris Head 1
Joint Structure and Function: A Comprehensive Analysis,  4th Edition. Pamela K. Levangie.  DSc, PT  Cynthia C. Norkin, editor. EdD, PT  Philadelphia:  F.A. Davis;  2005. http://www.fadavis.com ISBN-10  0-8036-1191-9 ISBN-13  978-0-8036-1191-7 588 p., illustrated  CAD $73.50

The fourth edition of Joint Structure and Function is geared toward physiotherapy students, but it also contains significant and useful information for practising clinicians in the area of musculoskeletal rehabilitation. The text is composed of five sections, which are divided into 14 chapters. The first section focuses on foundational concepts, including biomechanics and soft tissue properties. The second section examines the axial skeleton, with chapters outlining the vertebral column, the thorax, and the temporomandibular joint (TMJ). The third and fourth sections cover the upper and lower extremities respectively, while the last section is dedicated to integrated function, including posture and gait.

The section on biomechanics is especially strong and provides in-depth coverage of the types of biomechanics most relevant to physiotherapists: planes of movement, forces, and vectors. As in all sections of the text, clinically relevant examples are used throughout. However, this chapter lacks a table of abbreviations, which would help readers to better understand the equations and diagrams. The two subsequent chapters outline joint and muscle structure and function. In addition to providing an anatomical explanation of these tissues and their role within the human body, the authors outline how these structures respond to injury, stress, and aging, which are all important concepts for physiotherapists who wish to gain a greater understanding of injury and how rehabilitation attempts to maximize recovery.

The second section, on the axial skeleton, outlines vertebral anatomy and function, lung mechanics and respiratory function, and the function of core stability musculature. It is unusual in the level of detail it provides on TMJ function and disorder; although this section is not extensive, it does cover anatomy and pathology in detail.

The third section, on upper-extremity function, outlines relevant anatomy and common pathologies. Rotator cuff dysfunction, a large part of physiotherapy orthopaedic practice, is covered in only cursory detail. The lower-extremity section (section 4) does a good job of outlining function and pathology and includes excellent material on sub-talar joint function.

The last section is detailed in its analysis of posture, particularly gait mechanics. Also covered are the effects of various pathologies on these areas, as well as the effects of aging and of assistive devices.

In summary, the fourth edition of Joint Structure and Function is a well-researched and authoritatively written textbook outlining the anatomical basis for understanding tissue function and change. It focuses exclusively on areas relevant to physiotherapists and incorporates much recent research into its discussion. However, educators may have difficulty deciding just where this textbook fits within the physiotherapy curriculum. While it is much more than a biomechanics textbook, it is insufficient as a stand-alone anatomy text and only briefly outlines physiotherapy treatment effects. It is primarily a physiology book geared toward the physiotherapy profession, and in this role it does an excellent job.

Articles from Physiotherapy Canada are provided here courtesy of University of Toronto Press and the Canadian Physiotherapy Association

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