Author Q&A: Goodman and Fuller’s Pathology, 5th Edition

Goodman and Fuller’s Pathology, 5th Edition provides practical and easy access to information on specific diseases and conditions as they relate to physical therapy practice. Up-to-date coverage in this new edition includes guidelines, precautions, and contraindications for interventions with patients who have musculoskeletal or neuromuscular problems, as well as other medical conditions such as diabetes or heart disease.

In this Q&A, Rolando Lazaro, PT, PhD, DPT, Catherine C. Goodman, MBA, PT, CBP, and Kenda S. Fuller, PT, NCS, share their insights on the landscape of physical therapy and important topics covered in their new title.

What do you hope faculty and students take away from your title?

An understanding of pathology is foundational to the decisions made by physical therapists.  Knowledge of pathology provides the basis for understanding the health condition and is used throughout the decision-making process. It informs screening and examination strategies, evaluation, and prognosis for both activities and participation. This knowledge—along with knowledge of other concomitant conditions, personal, and environmental factors—assists the physical therapist in anticipating likely physiological responses to physical interventions. These will be essential to apply in the classroom for future physical therapists.

How have you seen physical therapy change over the years?

As the physical therapist’s scope of practice expanded to include more autonomy and professional responsibility, including direct access, physical therapists needed to effectively screen and triage patients, highlighting the importance of identifying ‘red flags’ associated with pathological conditions. Physical therapists are now trained extensively to recognize signs and symptoms of pathological conditions that may warrant referral to a medical provider.

Today, meditation, spirituality, mindfulness and the mind-body connection have also found a place in mainstream medicine. During the past 20 years, evidence has grown, suggesting meditation and mindfulness can reduce stress and anxiety and improve well-being and happiness. Evidence also demonstrates that meditation has direct physiologic effects including increasing cortical grey matter density in critical parts of the cortex as well as telomere length. This focus, combined with an understanding of the impact of pathology on movement and participation, has the potential to augment the physical therapist’s care of people who seek treatment.

The context in which knowledge of pathology is interpreted continues to evolve. As with each previous edition, the current edition has added content that encompass some of the fundamental considerations related to the microbiome, epigenetics, and spirituality, meditation, and the mind-body connection that relate directly to pathology and also to the implications for pathology on movement, activity and participation.

Why was it important to include new information on epigenetics as it relates to physical therapy?

Epigenetics directs us to look at ourselves within our environment and recognize how our internal and external environments impact and influence our health. By changing behaviors and mitigating the effects of stress we can potentially change the ‘readout’ of the genes. When we change the learned subconscious routines and patterns of thoughts, feelings, and emotions, we can change the mind and behaviors that create the environment that predicts and determines our health outcome.

It has been said then that we are not doomed by our genes or hardwired to be a certain way, or locked into a condition for the rest of our lives. Our goal with this new addition to the text is to help physical therapists understand their own health but also the health of our patients/clients in the context of these influences. The role of nutrition, mood, exercise, prolonged stress, resiliency and coping will be examined in the context of epigenetic factors.

How does regenerative medicine translate to physical rehabilitation management?

Regenerative rehabilitation has been defined as “the application of rehabilitation protocols and principles together with regenerative medicine therapeutics toward the goal of optimizing functional recovery through tissue regeneration, remodeling, or repair”. The rationale for regenerative rehabilitation includes three main areas, including:

  1. For functional tissue regeneration to occur, resident stem cells are dependent upon supporting cues from the microenvironment, or niche. These microenvironmental cues include vascularity, growth factor secretion, and neural signals, for example, all of which serve to direct stem cell fate.
  2. Stem cells “sense” static and dynamic physical aspects of their surroundings. Through a process known as “mechanotransduction”, or the conversion of physical stimuli into chemical responses, extrinsic signals may directly affect stem cell responses, such as gene expression and differentiation into a specific tissue lineage.
  3. Differentiation of stem cells into the tissue target is often a goal of stem cell therapeutics, and physical therapy may serve as an important adjunct therapy to promote functionality of the newly formed tissue. Future studies are needed to investigate the ability of physical therapy protocols to promote hypertrophy of the newly formed myofibers so as to maximize functional outcomes.

Clearly, physical therapists will play a major role in the success of regenerative medicine and tissue engineering approaches in the clinic, much in the same way that successful outcomes following an orthopedic procedure relies on well-defined post-surgical rehabilitation protocols.

Why was it important to include new information on genomics as it relates to physical therapy?

In this era of genomic medicine, we are witnessing the implementation and application of precision medicine in which prevention and intervention strategies are tailored to the individual based on analyses of genomic and cellular information, as well as information about their environment, activities, behavior, and social networks. “Exercise genomics” in the form of personalized rehabilitation programs based on DNA sequence variation, has been proposed and recommended.

The “science of the individual” as medical care has been described in this genomic era captures an individual’s unique genetic makeup, development, and experiences, all of which influence health and disease. Technologies such as whole-genome sequencing, although currently not routinely used in clinical practice, are likely to become increasingly used to generate genomic information in clinical settings. Clinicians must be prepared to support patients on a number of issues related to genomics.

Answers from this Q&A are condensed from the Goodman and Fuller’s Pathology, 5th Edition. Learn more about this textbook and the Evolve resources available for students and faculty.