National Wheelchair Managers’ Forum: Krys Jarvis standing down

Krys Jarvis

PMG Conference 2022

11th to 13th July 2022 in Telford. Our annual conference provides an educational programme, industry exhibition and networking events for professionals working in the field of posture and wheeled mobility.

Book Review - The Atlas of Surface Palpation


Nathan Robson

Trainee Clinical Scientist

27 January 2016

Title: Atlas of Surface Palpation: Anatomy of the Neck, Trunk, Upper and Lower Limbs (Third Edition)
Author: Serge Tixa
Publisher: Elsevier
ISBN: 978-0-7020-6225-4
Reviewer: Nathan Robson
Role: Trainee Clinical Scientist (Rehabilitation Engineering)
Organisation: Specialist Disability Service/Oxford Gait Laboratory/Oxfordshire Wheelchair Service/Rehabilitation Engineering Department, Oxford University Hospitals NHS Foundation Trust

This work is superbly set out, following a logical sequence both of the regions of the body and of the structures that comprise them; working from the head to the feet, through bony anatomy, musculature, joints and ligaments, and finally blood vessels and nerves. Colour coding and page titles help to locate information quickly, whilst a comprehensive index pinpoints information relevant to the palpation of specific structures which may span more than one area of the body. At the start of each section is a contents page dealing with palpation methodology which further helps with finding specific information and guides the practitioner.

Each palpable structure is clearly identified in both the detailed, well-labelled images and the accompanying text. Subjects have been selected so that the anatomy is clearly visible and well framed, helping the reader relate the local anatomy to surrounding structures.
Palpation methodology is clearly established, proceeding from easily identified landmarks in sequences of images accompanied by easy-to-follow instructions. Specific clinical notes are included, highlighting cases where it may be advantageous to palpate a specific structure, or outlining postures and movements in order to identify injury or damage to the structure being examined.

New for this edition is information on muscle attachment and motion resulting from specific muscle activity, plus innervations of the key muscles of each body region. Also included are illustrated anatomical dissection plates showing muscle location and routing, with labelled photographs indicating the attachment points of muscles relevant to the palpation being carried out. Similarly, principal nerves and blood vessels are illustrated, using a combination of anatomical dissection plates with palpable structures noted in labelled photographs. Where appropriate, palpation methodology is demonstrated to locate structures.

Whilst some specific knowledge of medical terminology, anatomy, and palpation methods is generally assumed, the methodology has been made so clear and easy to follow that even a novice is well guided in the location of structures, including those usually quite difficult to identify. The inclusion of additional information alongside the photographic and written instructions about bony structures, muscle attachments, muscle actions, nerves, blood vessels, together with clinically relevant notes, make this atlas an invaluable learning tool for gaining an understanding of the human musculoskeletal system and how it moves and functions.

For the more experienced, the atlas can act as an aide-memoire for the location and palpation technique of those structures which are not so routinely identified in examinations. In centres with multiple practitioners, potentially with different backgrounds and levels of experience, it can help facilitate the standardisation of assessments involving palpation, as well as the training of junior team members.

The Atlas of Surface Palpation is particularly valuable to those who rely on the correct identification of anatomical landmarks to carry out additional testing beyond standard strength and spasticity. Clinicians and engineers involved in fields such as gait analysis may find it a particularly helpful reference when placing markers and electromyography electrodes. For those involved in posture management, including static seating, wheelchair provision, and sleep systems, the atlas demonstrates palpation of a number of landmarks which can aid in assessing presenting posture and the degree to which it can be corrected; being able to determine the position of the pelvis accurately through bony palpation is paramount in assuring appropriate support is provided. Similarly, palpation of features - such as the coracoid process at the anterior surface of each shoulder - allows for a rough assessment of trunk curvature when considered relative to the position of the pelvis.

Clinicians and engineers working with clients who have complex postural needs will find this guide increasingly useful as they attempt to reliably and repeatedly identify anatomical landmarks in order to assess posture and mobility objectively and prescribe appropriately.

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