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"Knowledge comes, but wisdom lingers"—Alfred Tennyson

Welcome to the world of cardiovascular and pulmonary physical therapy! There are at least four things that we think you should know about this book:

• It reflects the broadest possible spectrum of cardiovascular and pulmonary physical therapy practice and draws upon the experience of the many experts who we recruited as chapter authors.
• The Guide to Physical Therapist Practice, second edition, is the framework we used for the description of tests, measures, and interventions. Our text links these tests, measures, and interventions with pathophysiologies in a case study format.
• This textbook provides an evidence base for many of the tests, measures, and interventions used by physical therapists.
• It is accompanied by a CD-ROM that provides the user with an interactive, visual workbook of case studies.

Why did we write this new second edition textbook for cardiovascular and pulmonary physical therapy? We believe that a fundamental paradigm shift has occurred in both the practice of physical therapy and the education of physical therapy students. These changes include health care cost containment, the introduction of the Guide to Physical Therapist Practice, and the utilization of the disablement model. Within the educational environment, these changes have moved the entry-level physical therapy degree to the doctoral level. This updated textbook reflects these dramatic changes.

Here are ways we believe our book helps physical therapists meet the challenges of this new environment:

• It integrates the Guide to Physical Therapist Practice. Chapter 2 describes both the history and use of the Guide.
• Preferred practice patterns for cardiovascular and pulmonary physical therapy form Chapters 15 through 22 and are used as springboards to describe interventions and outcomes.
• A case study in each practice pattern chapter permits the student to experience the proper application of the practice patterns.
• The patient–client management model is used in the case studies; appropriate tests, measures, and interventions are selected from the practice pattern and applied to the patient.
• Language has been standardized across chapters.
• "International Perspectives" provide ways to gain insight into the global practice of physical therapy. Prominant therapists from Australia, Canada, Japan, Singapore, and Colombia comment on physical therapy in their countries; these discussions allow comparison of clinical practice behaviors, which may differ from those in the United States.
• With the inclusion of an evidence base and peer-reviewed published research in this book, the physical therapist is able to "narrow the circle" and to develop more specific intervention regimens using hypothesis-oriented algorithms that clarify the use of the Guide. The limits of current knowledge are also provided as a stimulus to research.

Several chapters bear special mention:


• The newer ICF Model of Disablement is included in Chapter 2 of the second edition, with discussion of its utility.
• Exercise physiology coverage in Chapter 3 summarizes aspects of the field that are particularly applicable to physical therapy and applies it to patient care.
• Patients with orthopedic and neurological disease are addressed in Chapters 13 and 14, and the principles of cardiovascular and pulmonary physical therapy are applied to them.
• A new Chapter 16—Physical Therapy Associated with Obesity—recognizes this important area of medical practice and the expanding role of physical therapy services in its management.
• The history and future of cardiovascular and pulmonary physical therapy are addressed in Chapters 1 and 23 and provide the proper context for our craft.

We hope that this textbook will meet the needs of our rapidly changing profession as we move forward in the new millennium. Students will find this text replete with evidence that supports our craft. Practicing clinicians will find that the application and utility of our second edition will advance their skills.

William E. DeTurk
Lawrence P. Cahalin

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