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P R

hysical ehabilitation

Susan B. O’Sullivan, PT, EdD Professor and Chair Department of Physical Therapy School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts

Thomas J. Schmitz, PT, PhD Professor Division of Physical Therapy School of Health Professions Long Island University Brooklyn Campus Brooklyn, New York

F I F T H ED I T I O N

F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2007 by F.A. Davis Company Copyright © 1980, 1988, 1994, 2001, 2007 by F.A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmited in any form or by any means, electronic, mechanical photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Margaret Biblis Manager, Content Development: Deborah Thorp Developmental Editor: Jennifer Pine Design Manager: Carolyn O’Brien Photographer: Jaime Eric Eisman, ASMP Models: Frank J. Ciuba, DPT, MS; Clifford Weller As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The authors and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Physical rehabilitation/ [edited by] Susan B. O’Sullivan, Thomas J. Schmitz.—5th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-1247-1 ISBN-10: 0-8036-1247-8 1. Physical therapy. I. O’Sullivan, Susan B. II. Schmitz, Thomas J. [DNLM: 1. Physical Therapy Modalities. 2. Disability Evaluation. WB 460 P57763 2007] RM700.O88 2007 615.8⬘2—dc22 2006019334 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $. 10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1042/030 + $.10.

Preface With the fifth edition of Physical Rehabilitation, we continue a tradition of striving for excellence that began more than 20 years ago. We are gratified by the continuing wide acceptance of Physical Rehabilitation by both faculty and students. The text is designed to provide a comprehensive approach to the rehabilitation management of adult patients. As such, it is intended to serve as a primary textbook for professional-level physical therapy students, and as an important resource for practicing therapists as well as for other rehabilitation professionals. This fifth edition recognizes the continuing growth of the profession and integrates basic and applied clinical research to guide and inform evidencebased clinical practice. It also integrates terminology, practice patterns, specific tests and measures, and interventions presented in the American Physical Therapy Association’s Guide to Physical Therapist Practice. Physical Rehabilitation is organized into four sections. Section One (Chapters 1–3) provides an introduction to patient care and includes chapters on clinical decision making, psychosocial factors, and values. Section Two (Chapters 4–12) focuses on examination of the sensory, motor, and cardiovascular systems as well as examination of functional status and the environment. Section Three (Chapters 13–30) addresses the common diseases, disorders, or conditions seen in the rehabilitation setting. Appropriate examination and intervention strategies are discussed for related impairments, functional limitations, and disabilities. Emphasis is placed also on parameters of learning critical to ensuring the patient/client can achieve an independent and active lifestyle. The final section, Section Four (Chapters 31–33) includes orthotics, prosthetics, and the prescriptive wheelchair. A central element of the text is a strong pedagogical format designed to facilitate and reinforce the learning of key concepts. Each chapter of Physical Rehabilitation includes an initial content outline, learning objectives, an introduction and summary, study questions for self-assessment, and extensive references. Additional supplemental readings and recommended resources are also provided. Key terms are bolded throughout each chapter indicating their inclusion in a master glossary toward the end of the text. Application of important concepts is promoted through case study examples and problem-oriented guiding questions. New to the fifth edition, many chapters contain Evidence Summary

Boxes that summarize and critically appraise research focused on a particular topic or intervention relevant to the chapter content. Our hope is that the boxes may provide a model for readers to continue to critically examine clinical practice using validated clinical methodologies. We also hope it will inspire enthusiasm about the importance of continuous, lifelong self-directed learning, without which practice may become rapidly and dangerously out-of-date. The visual illustrations have been substantially enhanced with the addition of many new line drawings and photographs. Changes in design and the introduction of a twocolor format provide a more reader-friendly environment as well as augment understanding of content. Without question, our greatest asset in preparing the 5th edition of Physical Rehabilitation has been an outstanding group of contributing authors. We are most fortunate to have this group of talented individuals whose breadth and scope of professional knowledge and experience seems unparalleled. These individuals are recognized experts from a variety of specialty areas who have graciously shared their knowledge and clinical practice expertise by providing relevant, up-to-date, and practical information within their respective content areas. The fifth edition has also benefited from the input of numerous individuals engaged in both academic and clinical practice settings who have used and reviewed the content. We are grateful for their constructive feedback and have instituted many of their suggestions and changes. As always, we welcome suggestions for improvements from our colleagues and students. As physical therapists continue to take on more and greater professional responsibilities and challenges, the very nature of this text makes it a perpetual “work in progress.” We are grateful for the opportunity to contribute to the academic literature in physical therapy as well as to the professional development of those preparing to enter a career devoted to improving the quality of life of those we serve. We acknowledge the very important contributions that physical therapists make in the lives of their patients. This book is dedicated to those therapists—past, present, and future—who guide and challenge their patients to lead a successful and independent life. Susan B. O’Sullivan Thomas J. Schmitz v

Acknowledgments The on-going development of Physical Rehabilitation has been in all aspects a collaborative venture. Its fruition made possible only through the expertise and gracious contributions of many talented individuals. Our appreciation is considerable. Heartfelt thanks are extended to our contributing authors. Each has brought a unique body of knowledge as well as distinct clinical practice expertise to their respective chapters. Their commitment to physical therapist education is collectively displayed in content presentations that carefully reflect the scope of knowledge and skills required of a dynamic, evolving physical therapy practice environment. We are extremely grateful to each of our contributors as well as heartened by the excellence they bring to the fifth edition. Our gratitude is also extended to our guest editors and reviewers. Their collective expertise provided critical input during various phases of project development. We are particularly indebted to them for their content suggestions, pedagogical insights, and unconditional positive regard for the academic pursuits of physical therapy students. We thank those individuals and companies who contributed new photographs to the individual chapters and to those patients/clients who allowed their photographs to be used throughout the text. Our appreciation goes to the dedicated professionals at F.A. Davis Company, Philadelphia, PA: Margaret M. Biblis, Publisher, Jennifer A. Pine, Developmental Editor, Bob Butler, Production Manager, and Ron Moser, Marketing Manager. These individuals are recognized for their continued support, encouragement, and unwavering commitment to

excellence. We would also like to thank Jean-Francois Vilain, Former Publisher, FA Davis, for his support throughout previous editions of this text. Thanks also are extended to Berta Steiner, Director of Production, Bermedica Production Ltd, and to Deborah Lynam for her considerable talents in preparing many of the new line illustrations. We wish to thank the numerous students, faculty, and clinicians who over the years have used Physical Rehabilitation and provided us with meaningful and constructive comments that have greatly enhanced this edition. It is our sincere hope that this feedback will continue with the fifth edition. Our thanks go also to the following individuals who provided assistance during different phases of the project: Diana Agoston, Elizabeth Blas, Ryanne Glasper, Ellen Godwin, Kim Harris, Cristiana Kahl Collins, Katherine Li, Mary Maloney, Eileen McAulay, Michele Mills, Evangelos Pappas, Alexander Rosado, Alexis Sams, and Gideon F. Shapiro. A particular note of thanks is extended to Stephen A. Caronia who contributed several Evidence Summary Boxes as well as considerable editorial assistance; to Alisa Yalan-Murphy, Faculty Liaison, Faculty Media Resource Center, Long Island University, for her great patience in creating many high quality photographs; and to Ivaldo Costa whose support has truly been immeasurable. Finally, we are grateful for the continuing strong and productive working relationship that we maintain that has allowed us to complete a project of this scope through five editions. Susan B. O’Sullivan Thomas J. Schmitz

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Guest Editors Sharon A. Gutman, PhD, OTR Associate Professor Columbia University Programs in Occupational Therapy New York, New York Raymond Marx, CPO, FAAOP President Ortho-Bionics Laboratory, Inc. South Ozone Park, New York

Anne Hiller Scott, PhD, OTR, FAOTA Associate Professor Division of Occupational Therapy School of Health Professions Long Island University Brooklyn Campus Brooklyn, New York

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Contributing Authors Andrea L. Behrman, PT, PhD Associate Professor Department of Physical Therapy University of Florida Gainesville, Florida

Kate Grimes, DPT, MS, CCS Clinical Assistant Professor Graduate Programs in Physical Therapy MGH Institute of Health Professions Boston, Massachusetts

Research Health Scientist VA Brain Rehabilitation Research Center Malcom Randall VA Medical Center Gainesville, Florida

Andrew A. Guccione, DPT, PhD, FAPTA Senior Vice President Practice and Research Division American Physical Therapy Association Alexandria, Virginia

Adrienne Falk Bergen, PT, ATP Seating Specialist Delray Beach, Florida Lisa Janice Cohen, PT, MS, OCS The Body Mind Integration Center Watertown, Massachusetts Vanina Dal Bello-Haas, BScPT, PhD Associate Professor School of Physical Therapy University of Saskatchewan Saskatoon, Saskatchewan Canada Carol M. Davis, PT, EdD, MS, FAPTA Professor and Assistant Chair Department of Physical Therapy University of Miami Miller School of Medicine Coral Gables, Florida John L. Echternach, PT, EdD, ECS, FAPTA Professor and Eminent Scholar School of Physical Therapy Old Dominion University Norfolk, Virginia Joan E. Edelstein, PT, MA, FISPO Special Lecturer Program in Physical Therapy Columbia University New York, New York George D. Fulk, PT, PhD Assistant Professor Department of Physical Therapy Clarkson University Potsdam, New York

Deborah Graffis Kelly, PT, MSEd Associate Professor Division of Physical Therapy University of Kentucky Lexington, Kentucky Bella J. May, PT, EdD, FAPTA Professor Emerita Medical College of Georgia Augusta, Georgia President, BJM Enterprises Dublin, California Marian A. Minor, PT, PhD Professor and Chair Department of Physical Therapy School of Health Professions University of Missouri Columbia, Missouri Cynthia C. Norkin, PT, EdD Former Director and Associate Professor School of Physical Therapy Ohio University Athens, Ohio Sandra J. Olney, BSc (P & OT), MEd, PhD Professor and Director School of Rehabilitation Therapy Queen’s University Kingston, Ontario Canada

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Contributing Authors

Susan B. O’Sullivan, PT, EdD Professor and Chair Department of Physical Therapy School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts Leslie G. Portney, DPT, PhD, FAPTA Professor and Director Graduate Programs in Physical Therapy MGH Institute of Health Professions Boston, Massachusetts Pat Precin, OTR/L, MS, ABD Assistant Professor Department of Occupational Therapy New York Institute of Technology Old Westbury, New York Executive Director The Fostering Connection, Inc. Brooklyn, New York Consultant Pathways to Housing, Inc. New York, New York Reginald L. Richard, PT, MS Burn Clinical Specialist Physical Therapy Department Miami Valley Hospital Regional Burn Center Dayton, Ohio Serge H. Roy, PT, ScD Research Professor NeuroMuscular Research Center Boston University Boston, Massachusetts Martha Taylor Sarno, MA, MD (hon) Professor of Rehabilitation Medicine School of Medicine New York University New York, New York Director Speech-Language Pathology Department Rusk Institute of Rehabilitation Medicine New York University Medical Center New York, New York

David A. Scalzitti, PT, MS, OCS Associate Director Research Services American Physical Therapy Association Alexandria, Virginia Thomas J. Schmitz, PT, PhD Professor Division of Physical Therapy School of Health Professions Long Island University Brooklyn Campus Brooklyn, New York Michael C. Schubert, PT, PhD Assistant Professor The Department of Otolaryngology Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore, Maryland Julie Ann Starr, PT, MS, CCS Clinical Associate Professor Department of Physical Therapy and Athletic Training Sargent College of Health and Rehabilitation Sciences Boston University Boston, Massachusetts Carolyn A. Unsworth, OTR, PhD Associate Professor School of Occupational Therapy La Trobe University Bundoora, Victoria Australia R. Scott Ward, PT, PhD Professor and Chair Division of Physical Therapy University of Utah Salt Lake City, Utah D. Joyce White, PT, DSc Associate Professor Department of Physical Therapy School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts

Reviewers Candy Bahner, PT, MS Director and Assistant Professor Physical Therapist Assistant Program Washburn University Topeka, Kansas Marja Beaufait, PT, MA Associate Professor Physical Therapist Assistant Program St. Petersburg College St. Petersburg, Florida Wendy Bircher, PT, EdD Director Physical Therapist Assistant Program San Juan College Farmington, New Mexico Jill W. Bloss, PT, MPH Former Associate Professor Physical Therapy Program Nazareth College Rochester, New York Kathy Brewer PT, MEd, GCS Adjunct Faculty Department of Physical Therapy Arizona School of Health Sciences A.T. Still University Mesa, Arizona Suzanne Robben Brown, PT, MPH Director and Associate Professor Department of Physical Therapy Arizona School of Health Sciences A.T. Still University Mesa, Arizona Alice F. Cain, PT Clinical Coordinator Physical Therapist Assistant Technology Stark State College North Canton, Ohio Susan D. Calise, PT, MA Brookdale Department of Geriatrics and Adult Development Mount Sinai School of Medicine New York, New York

Sean M. Collins, PT, ScD, CCS Associate Professor Department of Physical Therapy School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts Sam M. Coppoletti, MPT, BS, CSCS Director and Assistant Professor Physical Therapist Assistant Program Shawnee State University Portsmouth, Ohio Linda Denney, PT, M.Appl.Sci. (Manip) Adjunct Assistant Professor Department of Physical Therapy Arizona School of Health Sciences A.T. Still University Mesa, Arizona George D. Fulk, PT, PhD Assistant Professor Department of Physical Therapy Clarkson University Potsdam, New York Christine Kowalski, PTA, EdD Director Physical Therapist Assistant Program Great Falls College of Technology Montana State University Great Falls, Montana Steven G. Lesh, PT, PhD, MPA, SCS, ATC Chair and Associate Professor Department of Physical Therapy Southwest Baptist University Bolivar, Missouri Marilyn Maxwell, PhD Instructor, English Department Hewlett High School Hewlett, New York Kathy Mercuris, PT, MGS Former Associate Professor Division of Physical Therapy Des Moines University-Osteopathic Medical Center Des Moines, Iowa xiii

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Reviewers

Robert J. Nelson, PT, MS, MPhil H & D Physical Therapy New York, New York Susan Roehrig, PT, PhD Associate Professor Program in Physical Therapy Arkansas State University Jonesboro, Arkansas Lynda L. Spangler, PT, MS, ACCE Assistant Professor Department of Physical Therapy The College of St. Scholastica Duluth, Minnesota Doreen Stiskal, PT, PhD Assistant Chair Graduate Programs in Health Sciences Seton Hall University South Orange, New Jersey

Kristin von Nieda, DPT, MEd Associate Professor Director, Transitional DPT Program Department of Physical Therapy Temple University Philadelphia, Pennsylvania Denise Wise, PT, PhD Chair and Assistant Professor Department of Physical Therapy The College of St. Scholastica Duluth, Minnesota Peter Zawicki, PT, MS Director Physical Therapist Assistant Program Gateway Community College Phoenix, Arizona

Table of Contents Section One: Introduction to Patient Care: Decision Making, Psychosocial Factors, and Values 1 Chapter 1: Clinical Decision Making

3

Susan B. O’Sullivan, PT, EdD

Chapter 2: Influence of Psychosocial Factors on Rehabilitation

27

Pat Precin, OTR/L, MS, ABD

Chapter 3: Influence of Values on Patient Care: Foundation for Decision Making

65

Carol M. Davis, PT, EdD, MS, FAPTA

Section Two: Examination Chapter 4: Vital Signs

79

81

Thomas J. Schmitz, PT, PhD

Chapter 5: Examination of Sensory Function

121

Thomas J. Schmitz, PT, PhD

Chapter...