Physical Rehabilitation - 7th Edition

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Library of Congress Cataloging-in-Publication Data

Names: O’Sullivan, Susan B., editor. | Schmitz, Thomas J., editor. | Fulk, George D., editor.
Title: Physical rehabilitation / [edited by] Susan B. O’Sullivan, Thomas J. Schmitz, George Fulk.
Description: Seventh edition. | Philadelphia: F.A. Davis Company, [2019]
Identifiers: LCCN 2018036884 (print) | LCCN 2018037477 (ebook) | ISBN 9780803694644 | ISBN 9780803661622
(hard cover)
Subjects: | MESH: Physical Therapy Modalities | Physical Examination | Disability Evaluation | Orthopedic Equipment
Classification: LCC RM700 (ebook) | LCC RM700 (print) | NLM WB 460 | DDC
615.8/2—dc23
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6162_FM_i-xxii 13/12/18 3:20 pm Page v

PREFACE

With the seventh edition of Physical Rehabilitation, we that these tables may provide a model for readers to con-
continue a tradition of striving for excellence that tinue to critically examine clinical practice using high-
began more than 35 years ago. We are gratified by the quality research findings. We also hope it will inspire
continuing wide acceptance of Physical Rehabilitation enthusiasm about the importance of continuous, life-
by faculty, students, and clinicians. long, self-directed learning.
The text is designed to provide a comprehensive The visuals have been enhanced with the addition
approach to the rehabilitation management of adult of new illustrations and photographs. Design changes
patients. As such, it is intended to serve as a primary text- and a full-color format provide a reader-friendly envi-
book for professional-level physical therapy students and ronment and augment understanding of content. Valu-
as an important resource for practicing therapists as well able resources for the seventh edition include 14 online
as for other rehabilitation professionals. The seventh case studies with accompanying video segments illus-
edition recognizes the continuing evolution of the pro- trating aspects of the initial examination, interventions,
fession and integrates basic and applied research to guide and outcomes for patients undergoing active rehabili-
and inform evidence-based practice. It also integrates tation. The cases were authored by practicing therapists
principles of patient/client management (examination, from various parts of the country who were directly in-
evaluation, diagnosis, prognosis, intervention, and out- volved in the care of the case study patient participant.
comes) presented in the American Physical Therapy The knowledge and clinical skills of these dedicated
Association’s Guide to Physical Therapist Practice and ter- case study contributors are well represented in the
minology from the World Health Organization’s Inter- online materials. The case studies include patients
national Classification of Functioning, Disability, and with chronic obstructive pulmonary disease and respi-
Health (ICF). ratory distress syndrome, burns, amputation, spinal
Physical Rehabilitation is organized into three sections. cord injury, Parkinson’s disease, traumatic brain injury,
Section One (Chapters 1–9) includes chapters on clini- stroke, vestibular dysfunction, and multiple sclerosis.
cal decision making and examination of basic systems as Questions are posed that address key elements in devel-
well as examination of function and the environment. oping the plan of care for each patient. All case study
Section Two (Chapters 10–29) addresses many of the materials (patient history, examination data, video seg-
diseases, disorders, and health conditions commonly ments, answers to guiding questions for student feed-
seen in the rehabilitation setting. Appropriate examina- back) are available online at DavisPlus. Suggested
tion and intervention strategies are discussed for related answers to the end-of-chapter case study Guiding Ques-
body structure/function impairments, activity limita- tions and Questions for Review (self-assessment) are also
tions, and participation restrictions in societal interac- available online.
tions. Health promotion and wellness strategies are also Online resources also include sample examination
considered. Emphasis is placed on parameters of learning questions consistent with the format of the National
critical to ensuring the patient/client can achieve iden- Physical Therapy Examination. In separate files, also
tified goals and expected outcomes. The final section, available at DavisPlus, answers to the questions are pro-
Section Three (Chapters 30–32), includes orthotics, vided for student feedback.
prosthetics, and seating and wheeled mobility. As we have gratefully noted with previous editions,
A central element of the text is a strong pedagogical our greatest asset and inspiration in preparing the sev-
format designed to facilitate and reinforce the learning enth edition of Physical Rehabilitation has been an ex-
of key concepts. Each chapter of Physical Rehabilitation traordinary group of contributing authors. We are most
includes an initial content outline, learning objectives, fortunate to have this group of talented individuals
an introduction and summary, questions for review (self- whose breadth and scope of professional knowledge and
assessment), and extensive references. Web-based re- experience seems unparalleled. These individuals are
sources for clinicians and patients/families are also recognized experts from a variety of specialty areas who
provided. Application of important concepts is pro- have graciously shared their knowledge and clinical
moted through end-of-chapter case studies, which in- practice expertise by providing relevant, up-to-date, and
clude guiding questions designed to enhance clinical practical information within their respective content
decision-making skills. Many health condition–focused areas.
chapters contain Tables of Outcome Measures emphasiz- The seventh edition has also benefited from the input
ing tests and measures commonly used in clinical prac- of numerous individuals engaged in both academic and
tice, and tables that summarize and critically appraise clinical practice settings who have used and reviewed the
research relevant to the chapter content. Our hope is content. We are grateful for their constructive feedback

v
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vi Preface

and have instituted many of their suggestions and changes. We acknowledge the very important contributions
As always, we welcome suggestions for improvements from that physical therapists make in the lives of their pa-
our colleagues and students. tients. This book is dedicated to those therapists—past,
As physical therapists continue to take on more and present, and future—who guide and challenge their
greater professional responsibilities and challenges, the patients to lead a successful and independent life and
very nature of this text makes it a perpetual “work in who work toward building a community to improve the
progress.” We are grateful for the opportunity to con- health of society.
tribute to the academic literature in physical therapy, as
—S USAN B. O’S ULLIVAN
well as to the professional development of those prepar-
T HOMAS J. S CHMITZ
ing to enter a career devoted to improving the quality of
G EORGE D. F ULK
life of those we serve.
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CONTRIBUTING EDITORS

Edward W. Bezkor, PT, DPT, OCS, MTC, CAFS Evangelos Pappas, PT, PhD, OCS
Case Study and Multimedia Editor Test Bank Coordinator

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CONTRIBUTING AUTHORS

Andrea L. Behrman, PT, PhD, FAPTA Kevin K. Chui, PT, DPT, PhD, GCS, OCS,
Professor CEEAA, FAAOMPT
Department of Neurological Surgery Director and Professor
Kentucky Spinal Cord Injury Research Center School of Physical Therapy and Athletic Training
University of Louisville College of Health Professions
Louisville, Kentucky Pacific University
Hillsboro, Oregon
Edward W. Bezkor, PT, DPT, OCS, CAFS
Assistant Professor Laura J. Cohen, PT, PhD, ATP/SMS
University of St. Augustine for Health Sciences Principal, Rehabilitation and Technology
Doctor of Physical Therapy Program Consultants, LLC
San Marcos, California Arlington, Virginia
Janet R. Bezner, PT, DPT, PhD, FAPTA Vanina Dal Bello-Haas, PT, PhD
Associate Professor Associate Professor
Texas State University Assistant Dean, Physiotherapy Program
College of Health Professions School of Rehabilitation Science
Department of Physical Therapy McMaster University
San Marcos, Texas Hamilton, Ontario, Canada
Beth Black, PT, DSc Judith E. Deutsch, PT, PhD, FAPTA
Associate Professor Professor and Director Rivers Lab
Physical Therapy Program Department of Rehabilitation and Movement Sciences
School of Health Sciences Rutgers Biomedical and Health Sciences
Oakland University Rutgers University
Rochester, Michigan Newark, New Jersey
Mark Bowden, PhD, PT Konrad J. Dias, PT, DPT, PhD, CCS
Associate Professor and Director, Division of Physical Professor
Therapy Program in Physical Therapy
Department of Health Professions Maryville University
College of Health Professions St Louis, Missouri
Medical University of South Carolina
Lee Dibble, PT, PhD, ATC
Charleston, South Carolina
Professor and Associate Chair
Judith M. Burnfield, PT, PhD University of Utah
Director, Institute for Rehabilitation Science and Department of Physical Therapy and Athletic Training
Engineering Salt Lake City, Utah
Director, Movement and Neurosciences Center
Joan E. Edelstein, PT, MA, FISPO
Clifton Chair in Physical Therapy and Movement
Special Lecturer
Science
Program in Physical Therapy
Institute for Rehabilitation Science and Engineering
Columbia University
Madonna Rehabilitation Hospitals
New York, New York
Lincoln, Nebraska
Nora E. Fritz, PT, DPT, PhD, NCS
Guilherme M. Cesar, PT, PhD
Assistant Professor, Physical Therapy and Neurology
Assistant Research Director, Movement and
Department of Health Care Sciences
Neurosciences Center
Eugene Applebaum College of Pharmacy and Health
Institute for Rehabilitation Science and Engineering
Sciences
Madonna Rehabilitation Hospitals
Wayne State University
Lincoln, Nebraska
Detroit, Michigan

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x Contributing Authors

George Fulk, PT, PhD Richard J. McKibben, PT, DSc, ECS

Professor and Chair Faculty, Doctor of Science in Health Science
Department of Physical Therapy Education Rocky Mountain University of Health Professions
College of Health Professions Provo, Utah
SUNY Upstate Medical University Owner/Electromyographer
Syracuse, New York Integrity Rehab Management, LLC
Hamilton, Georgia
Jessica Galgano, PhD, CCC-SLP
Adjunct Instructor Coby D. Nirider, PT, DPT, CBIS
Department of Rehabilitation Medicine Chief Clinical Officer
School of Medicine Brookhaven Hospital
New York University Neurologic Rehabilitation Institute
New York, New York Tulsa, Oklahoma
Maura Daly Iversen, PT, DPT, SD, MPH, FNAP, Cynthia C. Norkin, PT, EdD
FAPTA Associate Professor Emerita
Associate Dean, Clinical Education, Rehabilitation Founding Director
and New Initiatives, Bouvé College of Health Division of of Physical Therapy
Sciences School of Rehabilitation and Communications Studies
Professor, Department of Physical Therapy, Movement Ohio University
and Rehabilitation Sciences Athens, Ohio
School of Health Professions, Bouvé College of Health
Susan B. O’Sullivan, PT, EdD
Sciences
Professor Emerita
Affiliated Professor, College of Engineering
Department of Physical Therapy
Northeastern University
University of Massachusetts Lowell
Boston, Massachusetts
School of Health and Environment
Deborah G. Kelly, PT, DPT, MSEd Lowell, Massachusetts
Associate Professor
Evangelos Pappas, PT, PhD, OCS
Division of Physical Therapy
Associate Professor
Department of Rehabilitation Sciences
Faculty of Health Sciences
College of Health Sciences
Discipline of Physiotherapy
University of Kentucky
University of Sydney
Lexington, Kentucky
Lidcombe, New South Wales, Australia
Margery A. Lockard, PT, PhD
Ingrid S. Parry, PT, MS
Clinical Professor
Rehabilitation Research Therapist
Health Sciences Department
Shriners Hospital for Children, Northern California
Physical Therapy and Rehabilitation Sciences
University of California, Davis
Department
Sacramento, California
College of Nursing and Health Professions
Drexel University Leslie G. Portney, PT, DPT, PhD, FAPTA
Philadelphia, Pennsylvania Professor Emerita, Department of Physical Therapy
MGH Institute of Health Professions
Bella J. May, PT, EdD, FAPTA, CEEAA
Boston, Massachusetts
(1930–2016)
Formerly Professor Emerita Pat Precin, PhD, PsyD, NCPsyA, LP, OTR/L,
Georgia Health Science University FAOTA
Augusta, Georgia Associate Professor
Adjunct Professor of Physical Therapy Programs in Occupational Therapy
California State University Sacramento Columbia University
Sacramento, California New York, New York
Tara L. McIsaac, PT, PhD Reginald L. Richard, PT, MS (retired)
Associate Professor Formerly Clinical Research Coordinator Burn
Department of Physical Therapy Rehabilitation
Arizona School of Health Sciences U.S. Army Institute of Surgical Research
A.T. Still University Fort Sam Houston, Texas
Mesa, Arizona
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Contributing Authors xi

Leslie N. Russek, PT, DPT, PhD, OCS Carolyn A. Unsworth, OTR, PhD
Associate Professor Professor, Discipline of Occupational Therapy
Department of Physical Therapy Central Queensland University
Clarkson University Melbourne Campus
Potsdam, New York Melbourne, Victoria, Australia
Martha Taylor Sarno, MA, MD (hon) R. Scott Ward, PT, PhD, FAPTA
Research Professor Professor and Chair
Department of Rehabilitation Medicine Department of Physical Therapy and Athletic Training
School of Medicine College of Health
New York University University of Utah
New York, New York Salt Lake City, Utah
Faith Saftler Savage, PT, ATP Marie Westby, PT, PhD
Seating Specialist Physical Therapy Teaching Supervisor
The Boston Home Mary Pack Arthritis Program
Boston, Massachusetts Vancouver Coastal Health
Vancouver, British Columbia, Canada
David A. Scalzitti, PT, PhD
Assistant Professor D. Joyce White, PT, DSc, MS
Program in Physical Therapy Associate Professor Emerita
School of Medicine and Health Sciences Department of Physical Therapy
George Washington University University of Massachusetts Lowell
Washington, District of Columbia Lowell, Massachusetts
Thomas J. Schmitz, PT, PhD Christopher Kevin Wong, PT, PhD, OCS
Professor Emeritus Associate Director, Program in Physical Therapy
Department of Physical Therapy Associate Professor of Rehabilitation and Regenerative
School of Health Professions Medicine
Long Island University Columbia University Medical Center
Brooklyn, New York Program in Physical Therapy
New York, New York
Michael C. Schubert, PT, PhD
Associate Professor Sheng-Che Yen, PT, PhD
Laboratory of Vestibular NeuroAdaptation Assistant Professor
Department of Otolaryngology Head and Neck Department of Physical Therapy, Movement and
Surgery and Physical Medicine and Rehabilitation Rehabilitation Sciences
School of Medicine Bouvé College of Health Sciences
Johns Hopkins University Northeastern University
Baltimore, Maryland Boston, Massachusetts
Julie Ann Starr, PT, DPT, CCS
Clinical Associate Professor
Department of Physical Therapy
College of Health and Rehabilitation Sciences: Sargent
College
Boston University
Boston, Massachusetts
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ACKNOWLEDGMENTS

The ongoing development of Physical Rehabilitation has Many of the new patient photographs were possible
been in all aspects a collaborative venture. Its fruition owing to the efforts of Edward W. Bezkor and Robert
has been made possible only through the expertise and J. Schreyer and the photography expertise of Jason
gracious contributions of many talented individuals. Torres, J. Torres Photography, and Christopher Lenney.
Our appreciation is considerable. We thank also those individuals and companies who
Heartfelt thanks are extended to our contributing au- contributed new photographs to the individual chapters
thors. Each has brought a unique body of knowledge, as and to those patients/clients who allowed their photo-
well as distinct clinical practice expertise, to his and her graphs to be used throughout the text.
respective chapters. Their commitment to physical ther- We would like to thank Evangelos Pappas, Test Bank
apist education is collectively displayed in content pre- Editor, for his expertise and efforts in developing guide-
sentations that carefully reflect the scope of knowledge lines for questions consistent with the National Physical
and skills required of a dynamic, evolving physical ther- Therapy Examination format and soliciting expert item
apy practice environment. We are extremely grateful to writers for the test bank of examination questions. Our
each of our contributors and heartened by the excellence hope is that the test bank will become a valuable resource
they bring to the seventh edition. for both faculty and students who use our book.
Heartfelt thanks are also extended to the practicing Our appreciation goes to the dedicated professionals
clinicians who prepared the case studies and video seg- at F.A. Davis Company: Margaret M. Biblis, Editor-
ments. Their contributions expertly move text content in-Chief; Melissa Duffield, Senior Acquisitions Editor;
to clinical practice and significantly add to the devel- Jennifer A. Pine, Senior Developmental Editor; Amelia
opment of clinical reasoning skills of our readers. We Blevins, Developmental Editor, Digital Products; Julie
would like to thank Edward W. Bezkor, who served Chase, Content Project Manager; Sharon Lee, Produc-
tirelessly as Case Study and Multimedia Editor and ef- tion Manager; and Paul Marone, Marketing Manager.
fectively coordinated case study contributions as well These individuals are recognized for their continued sup-
as many production elements. Thanks also to Yvonne port, encouragement, and unwavering commitment
Gillam, Freelance Editor and Media Consultant, and to excellence. Thanks also are extended to Lynn Lusk,
Liz Schaeffer, Developmental Editor/Electronic Prod- Project Manager, Progressive Publishing Services.
ucts Coordinator, for their work in editing the patient We wish to thank the numerous students, faculty, and
videos. clinicians who over the years have used Physical Rehabil-
A note of special thanks is extended to the following in- itation and provided us with meaningful and constructive
dividuals for their assistance with filming the online video comments that have greatly enhanced this edition. It is
case studies: Jan BenDor, Producer and Videographer; our sincere hope that this feedback will continue.
Christine Flynn, New York College of Osteopathic Med- Finally, we are grateful for our continuing strong and
icine of New York Institute of Technology; Don Packard, productive working relationship that has allowed us to
University of Michigan Hospital; Robert Price, University complete a project of this scope through seven editions.
of Washington Medical Center; Sarah Ohiorhenuan,
—S USAN B. O’S ULLIVAN
California Rehabilitation Institute; and Evan T. Cohen,
T HOMAS J. S CHMITZ
Rutgers, The State University of New Jersey, School of
G EORGE D. F ULK
Health Professions.

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ABOUT THE AUTHORS

Dr. Susan B. O’Sullivan is Professor Emerita, Department of Physical Therapy,

University of Massachusetts Lowell. She is co-editor and contributing author of
Physical Rehabilitation, Improving Functional Outcomes in Physical Rehabilitation,
and Therapy Ed’s National Physical Therapy Examination Review and Study Guide.
She holds an EdD in Human Development from the School of Education and
Master of Science and Bachelor of Science degrees from Sargent College at Boston
University. Dr. O’Sullivan’s research, teaching, and clinical experience is in the area
of adult neurological rehabilitation. She has also held academic appointments at
Boston University. In 2012 the APTA Neurology Section honored Dr. O’Sullivan
with the Award for Excellence in Neurologic Education. She is also the recipient of
the University of Massachusetts Lowell Award for Teaching Excellence.

Dr. Thomas J. Schmitz is Professor Emeritus, Department of Physical Therapy,

Long Island University. He is co-editor and contributing author of Physical
Rehabilitation and Improving Functional Outcomes in Physical Rehabilitation. He
holds a PhD from New York University, a Master of Science degree from Boston
University, and a Bachelor of Science degree from SUNY at Buffalo. His primary
clinical experience is in the area of adult neurological rehabilitation. Dr. Schmitz
is the recipient of Long Island University’s David Newton Award for Excellence
in Teaching and the Trustees Award for Scholarly Achievement. He has also held
academic appointments at Boston University, Sargent College, and Columbia
University, College of Physicians and Surgeons.

Dr. George D. Fulk is Professor and Chair, Department of Physical Therapy Edu-
cation in the College of Health Professions at SUNY Upstate Medical University.
He is co-editor and contributing author of Physical Rehabilitation, and contributing
author of Improving Functional Outcomes in Physical Rehabilitation. He received his
entry-level physical therapy degree from the University of Massachusetts at Lowell
and his PhD from Nova Southeastern University. Dr. Fulk’s research, teaching, and
clinical expertise are in the areas of enhancing motor recovery and quality of life
in people with neurological health conditions. He has also held faculty appoint-
ments at Clarkson University in Potsdam, New York, and Notre Dame College in
Manchester, New Hampshire.
Dr. Fulk’s research has focused on measuring and improving locomotor capa-
bility in people with stroke. He has authored numerous journal articles, conference
papers, and textbook chapters in these areas. He is also the Digital Media Editor
and an Associate Editor for the Journal of Neurological Physical Therapy, and serves
as a reviewer for many peer-reviewed journals.

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CONTENTS

SECTION ONE: Clinical Decision Making and Examination

C h a p te r 1 : Clinical D ecisi on Maki ng 1
Susan B. O’Sullivan
C h a p te r 2 : Examinat io n of Vi tal Si gns 28
Thomas J. Schmitz
C h a p te r 3 : Examinat io n of Sensory Func ti on 73
Kevin K. Chui • Sheng-Che Yen • Thomas J. Schmitz
C h a p te r 4 : Mu s cu lo s kele tal Exami nati on 109
Evangelos Pappas • D. Joyce White
C h a p te r 5 : Examinat io n of Motor Functi on: Motor Control and Motor Learnin g 135
Susan B. O’Sullivan • Richard J. McKibben • Leslie G. Portney
C h a p te r 6 : Examinat io n of Coordi nati on and B al anc e 188
Thomas J. Schmitz • Susan B. O’Sullivan
C h a p te r 7 : Examinat io n of G ai t 228
Judith M. Burnfield • Guilherme M. Cesar • Cynthia C. Norkin
C h a p te r 8 : Examinat io n of Func ti on 294
David A. Scalzitti
C h a p te r 9 : Examinat io n and Modi fi cati on of the Envi ronment 316
Thomas J. Schmitz

SECTION TWO: Intervention Strategies for Rehabilitation

C h a p te r 1 0 : St rat eg ies t o Improve Motor Functi on 361
Susan B. O’Sullivan
C h a p te r 1 1 : St rat eg ies t o Improve Locomotor Func ti on 400
George D. Fulk • Lee Dibble • Thomas J. Schmitz
C h a p te r 1 2 : Chro nic P u lmonary Dysfunc ti on 434
Julie Ann Starr
C h a p te r 1 3 : Heart D is eas e 469
Konrad J. Dias
C h a p te r 1 4 : Vascu lar, L ymphati c, and Integumentary Di sorders 524
Deborah Graffis Kelly
C h a p te r 1 5 : St ro ke 592
Judith E. Deutsch • Susan B. O’Sullivan
C h a p te r 1 6 : Mu lt ip le Scle rosi s 662
Tara L. McIsaac • Nora E. Fritz • Susan B. O’Sullivan
C h a p te r 1 7 : Amyo t ro p hic Lateral Sc l erosi s 712
Vanina Dal Bello-Haas
C h a p te r 1 8 : P arkins o n’s Di sease 760
Edward W. Bezkor • Tara L. McIsaac • Susan B. O’Sullivan
C h a p te r 1 9 : Trau mat ic Br ai n Inj ury 817
George D. Fulk • Coby Nirider
C h a p te r 2 0 : Trau mat ic Spi nal Cord Inj ury 855
George D. Fulk • Mark Bowden • Andrea L. Behrman

xvii