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Physiother Can. 2009 Summer; 61(3): 174–176.
Published online 2009 July. doi:  10.3138/physio.61.3.174
PMCID: PMC2787574

Book Reviews

Physiother Can. 2009 Summer; 61(3): 174–175.
Published online 2009 July. doi:  10.3138/physio.61.3.174

Perspectives on Disability and Rehabilitation: Contesting Assumptions, Challenging Practice

Chris Carpenter, PT, PhD, Reader in Physiotherapy
Perspectives on Disability and Rehabilitation: Contesting Assumptions, Challenging Practice.
Karen Whalley Hammell Edinburgh: Churchill Livingstone Elsevier. 2006 ISBN  0-443-10059-4.  p.  CAD $64.95

Important developments in rehabilitation, such as evidence-based and client-centred models of practice, have revealed what has been called the theory–practice gap. This gap is illustrated by the divergence of holistic and biomechanical approaches to rehabilitation therapy, perceived inconsistencies between professional education and clinical practice, and the gap between the “best” research evidence and the reality of practice. The theories of rehabilitation espoused by rehabilitation professionals have been uncritically accepted; they are restrictive in nature; and their influence on practice and research is poorly articulated. In addition, rehabilitation professionals have not been encouraged to examine how their own assumptions, perspectives, and knowledge about disability have been privileged and how they direct rehabilitation research and services. The increased availability of community-based rehabilitation services also highlights the importance of developing theories that emerge from and are relevant to the social, political, economic, and cultural contexts in which clients live. It is clearly imperative that the theories, concepts, and assumptions central to rehabilitation practice be examined systematically and critically. Such issues and concerns clearly motivated Karen Whalley Hammell to produce this book.

The fundamental aim of Perspectives on Disability and Rehabilitation is to provide an accessible introduction to a number of different theoretical perspectives on disability and rehabilitation. In doing so, Hammell effectively integrates the current literature from a number of interrelated disciplines (e.g., sociology, anthropology, the humanities, disability studies) and applies these perspectives to practical rehabilitation examples. This brief description, if left without further comment, would be a gross simplification of the more complex purpose and passion that characterize this book. The author clearly wishes to encourage readers to reflect critically on the taken-for-granted nature of traditional professional knowledge and of the ideologies and assumptions that direct rehabilitation services and “problematize” physical difference and disability. Her critical approach to these issues is clearly established in the carefully constructed title and by the consistent use of such terms as “contest,” “challenge,” “question,” “stimulate,” “renew understanding,” “interrogate,” and “critique” throughout the book. Contentious terminology (e.g., “expert,” “disabled people,” “managed,” “normal”) is consistently identified and discussed, and accurate definitions of terms are provided within the chapters and in a useful glossary. This is a book in which arguments are passionately developed with the desire to counteract traditional assumptions about disability, professional complacency, and ideologies that support hierarchical power structures within rehabilitation and health care. It requires the readers to set aside their “received” professional wisdom, evaluate their personal beliefs and understanding of disability and their rehabilitation role, and approach the arguments made from an inquiring and open-minded rather than defensive stance.

Perspectives on Disability and Rehabilitation consists of 10 chapters in which the author clearly presents the theoretical concepts and develops her arguments. The first three chapters form the foundation for subsequent discussions of the theoretical perspectives and other issues central to rehabilitation. The assumptions underpinning rehabilitation are presented and challenged. The International Classification of Functioning, Disability and Health (ICF) is critiqued in relation to the ideology of normality that underpins it, and the consequences of the ICF’s pervasive use as a framework for rehabilitation practice and research, in terms of the disenfranchisement of disabled people and the perpetuation of injustice, are discussed. The three dominant theoretical models of disability—the moral/religious model, the individual/medical model, and the social/political model—are discussed in terms of their impact on the lives of disabled people and their influence on rehabilitation.

The remainder of the book explores issues central to rehabilitation, such as the cultural representation and reinforcement of disability, the nature of the body and physical impairment, the concepts of independence and quality of life as goals of rehabilitation, and evidence-based and client-centred practice. Discussion of these issues is consistently grounded in the theoretical models of disability and the available research evidence, and the implications for education, practice, service delivery, theoretical development, and research in the rehabilitation professions are examined. The author also explores the intersection between the client-centred philosophy espoused in the rehabilitation literature and the development of rehabilitation theory and research. She advocates a more critical approach to the establishment of agendas for research into disability and rehabilitation and to identifying rehabilitation issues that are relevant, meaningful, useful, and valuable to disabled people.

Hammell draws on her considerable experience as an occupational therapist, academic, and author to create this unique and important text for practitioners and researchers in rehabilitation. There is much to be gained from this book, if approached in a spirit of exploration and critical examination, in terms of a deeper understanding of how society, culture, and health care systems contribute to disability; the relationship between rehabilitation clients and practitioners; and an enhanced personal and professional self-awareness. It is a pleasure to recommend this book to entry-level and graduate physical therapy students and to practising clinicians wishing to engage in a critical exploration of their rehabilitation practice.

Physiother Can. 2009 Summer; 61(3): 175–176.
Published online 2009 July. doi:  10.3138/physio.61.3.174

Disability Sport, 2nd Edition

Jane Freure, BSc(PT), MManipTher(AU), Diploma in Sport PT, FCAMT, Physiotherapist
Disability Sport, 2nd Edition.
Karen P. DePauw, Susan J. Gavron Windsor, ON: Human Kinetics. 2005 ISBN  0-7360-4638-0.  p.; illustrated  CAD $59.95

Disability Sport is an excellent introductory resource for athletes dealing with a new disability or for health care professionals working with such athletes. The text provides varied information, ranging from historical perspectives to specifics about international events, organizations, and special sport considerations.

This text outlines the three main international competitions for athletes with disabilities—the Paralympics, the Deaflympics, and the International Special Olympics—as well as providing an introduction to some of the smaller games. It includes past and future event dates as well as information about athlete classification, formation of equal playing fields, and special health care needs.

I found the section that briefly outlines each sporting event at the Paralympics helpful, but I would have welcomed even more specific details. The section “Injuries, Incidence, Care, Prevention” is a good starting point for those ordering event supplies based on expected incidence of injuries for wheelchair sport. The chapter is well referenced, but would have been more useful if the authors had provided sport-specific statistics instead of generalizing under the umbrella of wheelchair sports. I particularly liked Table 9.4, which outlines contraindications to exercise for specific disability, but I was disappointed that this was not further elaborated upon with respect to thermal regulation in spinal-cord injury athletes, autonomic dysreflexia, and “boosting,” as well as more specific details on what types of braces (e.g., forearm) and belts to include in event preparation. A specific “trainer's kit” list from an athletic therapist or physical therapist experienced in working with this type of athletic population would also have been helpful.

I was impressed to note that throughout this predominantly American text the authors have chosen to mention international successes and provide biographies of athletes with disabilities from around the world. On a personal visit to Variety Village Sport Training and Fitness Centre in Scarborough, Ontario, years ago, I was awed by the level of skill and athleticism in disability sport. If you have not been to the centre, it is well worth a visit. The authors tout it as “North America's model of accessibility … a multipurpose sport training facility with no physical or psychological barriers in an integrated setting of able-bodied and disabled sport enthusiasts” (p. 108). They go on to outline the features that make the centre so unique and effective.

Disability Sport provides many “fast facts” on athletes who have excelled in disability sport. These success stories are worthy of recognition. The authors provide a list of resources to help those seeking the right equipment; the appendix is comprehensive and provides helpful information on international resources for disability sport. The addition of a similar anecdote from one of the more experienced health care providers, including practical tips for on-field coverage, would have been useful to those of us who are less experienced in the area. The text would be more user friendly if each sporting event outlined included statistics on the most frequently sustained injuries and any special first aid or rehabilitative equipment to have on hand at such an event.

Overall, Disability Sport is an excellent resource for contact information on international disability sport organizations, equipment, and periodical and journal resources. I would have valued additional practical details, but the text is an excellent starting point for those just becoming involved in disability sport. It emphasizes the need for continued research and support for disability sport and highlights many outstanding athletes worthy of our admiration.

Physiother Can. 2009 Summer; 61(3): 176.
Published online 2009 July. doi:  10.3138/physio.61.3.174

Anatomy of Exercise: A Trainer's Inside Guide to Your Workout

Sue Murphy, MEd, BHSc
Anatomy of Exercise: A Trainer's Inside Guide to Your Workout.
Pat Manocchia Richmond Hill, ON: Firefly Books. 2008 ISBN  1-55407-375-8.  p., illustrated  CAD $35.00

This beautifully illustrated book opens with diagrams of muscular anatomy followed by sections on warm-ups and stretching exercises, before leading into sections on specific exercises for different areas of the body, such as “legs and hips” and “chest.” The book clearly depicts the use of stabilizing muscles and the biomechanics of common exercises, with excellent diagrams and photographs showing the muscular activity of the exercises. At the back of the book are a glossary of terms and a “Latin glossary,” which describes the origins of the names of specific muscles (the rationale for including this is somewhat unclear, other than for general interest).

Anatomy of Exercise appears to be intended as a manual on how to perform the illustrated exercises correctly. Suggestions for individualized exercise programmes are not given, and the author suggests that exercise programmes are best prescribed by a professional. The exercises depicted and described target fit and active adults; variations of exercises to increase difficulty are given in some instances, but modifications for decreasing difficulty are disturbingly absent.

This book is described as a “professional level book … tailored to the general reader.” Given this challenging mandate, it is perhaps not surprising that Anatomy of Exercise appears to suffer from an identity crisis; despite the attempt to appeal to a wide target audience, it is not clear who might actually find this book useful. The text is a confusing mix of technical jargon and lay terms, with sometimes inadequate explanations of what the technical terms actually mean. The very limited descriptions of movement terminology in the glossary are not particularly helpful to a lay reader (e.g., “adduction: movement towards the body”), and some descriptions of movement in the text are unclear to those unfamiliar with biomechanics (e.g., “your torso rotates around your centre of mass”). Errors also make the text confusing (e.g., “the muscles of the upper leg operate the humerus at the hip and the tibia and fibula at the knee”). Similarly, concepts such as “neutral position of the spine” and the “inherently mobile” structure of the shoulder joint are not adequately explained, yet are used as a basis for exercise instructions.

This book would perhaps have been of more use before the days of computer animation, which can show three-dimensional movement much more effectively than a textbook page. If the content were edited to ensure accuracy and reframed for a more specific audience, and the exercises presented actively on a CD-ROM, Anatomy of Exercise might be a useful tool for those involved in the prescription of home exercise programmes for fit adults; at present, it is questionable what reader audience will find this book of use.

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