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This book is the culmination of twenty-eight years of clinical practice, clinical inquiry, reading, writing, and teaching. I count my work as among one of my life’s greatest blessings. I still love what I do as much as I did during my first clinical experience as a young volunteer, then as a student, therapist, and now teacher. How fortunate I am to awaken every day being able to do what I love!

This book literally has been in my head for about the past decade. As a board certified clinical specialist within the physical therapy profession and an educator in both physical therapy and occupational therapy programs, every day I see the symbiosis that must exist between clinical practice and advances in that profession’s knowledge base. Informed clinical practice and ongoing scientific advances are equal catalysts for dedicated professionals who attempt to bring the best and most current insights to the practice arena for the benefit of the patient/client. Actually, the most exciting feature about the rehabilitation field is the dynamic, evolving nature of the field. As knowledge in the basic sciences increases, there will be a natural evolution of therapeutic approaches as practitioners develop their expertise in applying this new neuroscience knowledge to patient care. Concurrently, experienced practitioners will demand innovative answers and new ideas from the basic scientists to further develop the evolution of practice insights that occur in the science of clinical application. This text, as with others, will need ongoing revision as knowledge emerges and as clinicians and applied researchers strive for effectiveness, evidence, and measurable outcomes in clinical application.

The purpose of this text is to provide an integrated approach to basic neuroscience and applied neurorehabilitation, presented with practical applications illustrating the functional implications of neurological damage. This book attempts to answer one main question often posed by entry-level practitioners in the fields of occupational therapy and physical therapy as they initially encounter individuals with movement impairments and subsequent functional limitations caused by neurological disorders:

Do not tell me only what is going on with the patient/client, but more importantly, what can I do to improve that person’s function, where do I start, and how do I try to ensure that my intervention is really meaningful to that individual?

This text attempts to present the essentials of neuroscience and movement control and to provide practical applications by offering solutions to commonly encountered clinical dilemmas affecting an individual’s ability to move effectively and efficiently as he or she attempts to function the best that he or she can under his or her unique given circumstances. This text presents a practical and therefore unique perspective to well-established and emergent rehabilitation practice. There really is no totally new information but rather unusual and fresh combinations of materials that have been presented elsewhere. What is new and original is the lens through which the same material is viewed, the lens of an educator and a problem-solving, experienced clinician.

Becoming a master clinician is possible only because of the teaching and insight gained from many of the professions’ great masters. Although I reference the works of many authors throughout the text, it is imperative that I note, with deep humility, the guidance and knowledge already available from so many of our professions’ leaders. Leaders and authors like Anne Shumway-Cook, Marjorie Woollacott, Susan O’Sullivan, Thomas Schmitz, Catherine Trombly, Janet Carr, Roberta Shepherd, Rona Alexander, Regi Boehme, Barbara Cupps, Lois Bly, Suzanne Campbell, Jane Case-Smith, Susan Duff, Susan Miller Porr, Ellen Berger Rainville, Darcy Umphred, Susan Ryerson, Kathryn Levit, Donna Cech, Suzanne “Tink” Martin, Mary Kessler, Laurie Lundy-Ekman, Jane Styer-Acevedo, Ann VanSant, Pamela Duncan, Faye Horak, Joan Valvans, Toby Long, Susan Herdman, Helen Cohen, Jacqueline Perry, Chuck Leonard, Katherine Ratliffe, Carol Oatis, and Becky Craik have all contributed great works from which our students and patients can benefit. I certainly have learned a great deal from all these talented leaders in the rehabilitation profession. I have built upon the work of these authors and acknowledge the contributions they have made to our professional body of knowledge. As cited throughout this text, I have attempted to reframe much of the information from the writings from these leaders into a consolidated, practical approach to life span intervention. This text attempts to present “best practice” insights, made clinically meaningful and easily applicable to patient care. This text is different in that it attempts to be extremely practical, focused on functional but personally meaningful outcomes, and approaches an understanding of the individual presenting for intervention at any stage throughout the life span.

As a physical therapist, I always have respected and relied on the professional expertise of my colleagues in the occupational therapy profession. I am honored to have been joined by the author of the Occupational Therapy Guide to Practice, Penelope Moyers, Ed.D. OTR/L, FAOTA, as a coauthor of Chapter 1. This introductory chapter portrays with intention the importance of both collegial teamwork and respect for professional autonomy. I also am honored to have the contributions of Catherine Emery, MS, OTR/L, BCN and Doré Blanchet, MS, OTR/L in Chapters 8 and 9 respectively. These talented occupational therapists are among the faculty at Alvernia College, and I am delighted to work side by side with them. Kate (Catherine Emery) is board certified in neurological occupational therapy and Doré Blanchet is a pediatric occupational therapist, with sensory integration certification.

This book is intended for use by educators and clinicians within physical therapy and occupational therapy. Although both professions are complementary, they are different and separate. The client, however, is one whole individual who often presents with multiple needs. The different and uniquely valuable insights of both professions reflect the separate roles of the rehabilitation team, all of whom are focused on maximizing an effective interaction between the person, the activity, and the environment, thereby facilitating an “enabling” rather than a “disabling” process. Occupational therapy and physical therapy professionals are locked arm in arm with helping their patients/clients strive for the overarching goal of improved function. The differences and unique skills characteristic of each discipline support the need for a close working relationship to thoroughly solve the problems of functioning in a way that might not be achieved by one discipline. Celebrating differences as well as similarities creates unending opportunities for professional growth. Ultimately, the patient clearly benefits from this collegial relationship. I have enjoyed creating this text and sincerely hope that it finds a place among its partners as the professions of physical therapy and occupational therapy continue to evolve and refine.

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