Textbook

of
Rehabilitation
 Textbook
of
Rehabilitation
THIRD EDITION

S Sunder MBBS Dip Phys Med

Consultant in Physical Medicine and Rehabilitation
Medical Director
Prem Center for Physical Medicine and
Rehabilitation Medicine
Chennai, Tamil Nadu, India
Chief Consultant
Global Hospital and Health City
Chennai, Tamil Nadu, India

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Textbook of Rehabilitation
© 2010, S Sunder
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or
transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort
is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible
for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi
jurisdiction only.

Second Edition: 2002

Reprint: 2003, 2004, 2005, 2007
Third Edition: 2010
ISBN 978-81-8448-711-4
Typeset at JPBMP typesetting unit
Printed at
 Preface to the Third Edition

During my tenure as a medical intern I came across several ‘cases’ of hemiplegia,

paraplegia and Parkinson’s disease in the Department of Neurology. Our case
discussions would cover the clinical presentation, the investigation and the
therapeutics for the disease concerned, but would often stop short of
rehabilitation and physical management. Considering that rehabilitation is a
vital aspect of post-acute care, and that the ‘cases’ were actually patients who
needed to get back to living their lives, I often would wonder why it was not
touched upon. Later, when I went on to do my postgraduation in Rehabilitation
Medicine, I realized the immense scope that it provided, and that it does not
feature as a subject in our medical curriculum. There is, as a result, a need for a
Comprehensive Textbook on rehabilitation medicine for our students.
This book, hopefully, will fulfil that need, and since it conforms to the syllabus
of physiotherapy and occupational therapy, would immensely benefit students
of those disciplines, or indeed anyone who is rehabilitation professional. Also,
wherever possible, the use of appropriate technology has been included.
This revised edition follows-up on the enormous success of the second
edition. Many chapters have been rewritten and photographs added. This book
is divided into two parts—Part one deals with General Principles of
Rehabilitation while the second part is concerned with the application of these
principles in various conditions. There are many disabling diseases and it is
beyond the scope of this book to list out all of them, as also the various lines of
management. The focus is therefore to bring out the philosophy of rehabilitation
and its importance in some of the common neurological and orthopedic
conditions. Techniques and technology in rehabilitation (and the various
specialties in rehabilitation) have advanced so dramatically in the last decade
that it is virtually impossible to bring all aspects into a textbook of this nature.
I gratefully acknowledge the permission granted by Freedom Trust, KCRC,
Electrocare Systems and Services, RASA Amar Seva Sangam and Callidai Motor
Works to use photographs to illustrate some of the points in this book.
I acknowledge with gratitude the contribution of Rupa Balaraman, in helping
with some of the material for this book.
I realize that my own patients have been my clinical teachers and I dedicate
this book to them.

S Sunder
 Contents

Part I: General Principles of Rehabilitation

1. Introduction to Rehabilitation Medicine ................................................. 3
2. Delivery of Rehabilitation Care: The Team .......................................... 16
3. Therapeutic Exercises and Other Alternative Techniques in
Treatment ................................................................................................... 33
4. Sociolegal Aspects of Rehabilitation ...................................................... 72
5. Principles in Management of Communication Impairment .............. 83
6. Behavioral and Learning Problems in the Disabled ......................... 104
7. Orthotics .................................................................................................... 122
8. Amputation and Prosthetics .................................................................. 155
9. Mobility Aids ............................................................................................ 200
10. Architectural Barriers ............................................................................. 218
11. Activities of Daily Living ........................................................................ 232
12. Vocational Rehabilitation ....................................................................... 245
13. Physical Agents Used in the Management of
Pain and Paralysis ................................................................................... 261

Part II: Applied Rehabilitative Conditions

14. Congenital Malformations ..................................................................... 299
15. Rehabilitation of Cerebral Palsy ........................................................... 315
16. Rehabilitation of Poliomyelitis .............................................................. 330
17. Rehabilitation of Brain Injury ............................................................... 339
18. Stroke Rehabilitation .............................................................................. 351
19. Peripheral Nerve Injuries ...................................................................... 362
20. Common Deformities and the Role of
Surgery in Rehabilitation ....................................................................... 377
21. Rehabilitation of Muscular Dystrophy ................................................ 393
22. Rehabilitation of Spinal Cord Injury .................................................... 402
23. Sports Rehabilitation and Exercises for Positive Health ................... 429
24. Other Neurological Conditions ............................................................. 449
25. Cardiac and Pulmonary Rehabilitation ............................................... 458
26. Vascular and Hematological Conditions ............................................. 472
27. Rehabilitation of Burns .......................................................................... 479
28. Rehabilitation of Arthritis ...................................................................... 488
29. Rehabilitation of Fractures ..................................................................... 503
30. Common Pain Syndromes ..................................................................... 514
Bibliography ............................................................................................... 527
Index ........................................................................................................... 529