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Functional Electrical Rehabilitation: Technological Restoration After Spinal Cord Injury
Book Reviews Intravascular Ultrasound Imaging, by Douglas M. Cavaye and Rodney A. White, 119 pp, with illus, $59, New York, Raven Press, 1993 Recently, ultrasound transducers have been miniaturized, attached to a small catheter tip, and extended through blood vessels to obtain intraluminal vascular images. This technologic advance allows physicians to enter an artery and examine the detailed characteristics of atherosclerotic plaques and other arterial disorders. Journal articles on this topic are rapidly accumulating, but few reference sources exist. In the truest sense, this book is a monograph or a primer on intravascular ultrasound imaging. The authors' goal is to provide a concise, well-illustrated text that allows readers to gain a comprehensive understanding of intravascular ultrasound and basic principles of complex clinical and research applications. They achieved this goal in a highly readable manner. Their presentation is clearly directed at the novice in this field. The basic concepts are lucid. Numerous schematic drawings clarify the textual material, and ultrasound images demonstrate both the normal and the abnormal anatomy. The initial chapters provide a superficial but useful review of the changing spectrum of cardiovascular intervention, the pathophysiologic features of vascular diseases, and the basic physics of ultrasound. The rationale for the development of internal ultrasound imaging is explained and offers readers some insight into specific modifications that may be necessary for future use. Subsequent chapters provide specific technical tips in performing the procedure and introduce the principles of computerized image processing, including three-dimensional reconstruction. The final chapter summarizes the current and developing clinical applications of intravascular ultrasound. One of the most refreshing features of this primer is that it can easily be perused in one evening. In a comfortable armchair and with a cup of coffee or tea, the reader is more likely to be stimulated by this excellent monograph than be sedated. I recommend this pioneering text on intravascular ultrasound imaging to physicians who specialize in cardiovascular diseases. John W. Hallett, M.D. Division of Vascular Surgery
Disorders of the Pancreas: Current Issues in Diagnosis and Management, edited by Gerard P. Bums and Simmy Bank, 506 pp, with illus, $80, New York, McGraw-Hill, 1992 To quote Yogi Berra: "This is deja vu allover again." I was a fledgling student in a different country when I first encountered Dr. Bank, one of the editors of Disorders ofthe Pancreas. At that time, he was a stimulating educator and a catalyst of new ideas. Time has not changed these admirable abilities. Dr. Bank and his coeditor Dr. Bums have collated the talents and experiences of a group of dedicated pancreatologists (should they be called an islet?) from Mayo Clin Proc 1993; 68:721-725
various specialties and parts of the world. In the foreword, the editors are somewhat apologetic for the incompleteness of this contribution; this is one of the few mistakes encountered-the editors have no need to apologize because this text is an enticing and comprehensive pancreatic smorgasbord. All persons with an interest in the pancreas will find what they are looking for. If their interest is experimental, the intriguing issue of pancreatic regeneration is addressed by Dreiling; if their interest is radiologic, all aspects are covered in more than one chapter; and if their interest is either medical or surgical therapy, excellent contributions by Marks, Ranson, Warshaw, Thompson, Frey, Moosa, Anderson, Pitt, and Blumgart are provided. The important issue of pain management in pancreatic disorders is well covered as is adjuvant therapy for pancreatic malignant disease. For me, a highlight of reviewing this text was careful perusal of the editorial comments and statements of the controversy to be addressed that precede each chapter. These concise and insightful comments reflect the expertise and clear understanding of both editorial pancreatologists about the somewhat hidden, often feared, highly respected, and ubiquitous pancreas. All medical professionals who are responsible for the care of patients afflicted with diseases of the pancreas will enjoy this excellent contribution. Jon A. van Heerden, M.B.,Ch.B. Division of Gastroenterologic and General Surgery
Functional Electrical Rehabilitation: Technological Restoration After Spinal Cord Injury, by Chandler Allen Phillips, 209 pp, with illus, $98, New York, Springer-Verlag, 1991 One new technique in the rehabilitation of people with spinal cord injuries is electrical stimulation of paralyzed muscles. Functional electrical stimulation (FES) can be used to achieve several goals, including building muscle bulk in paralyzed muscles, improving cardiopulmonary fitness, and assisting with ambulation. This book describes the background and approach to the use of FES for lower extremities as it evolved in the programs at Wright State University. Most techniques presented have been done by Drs. Phillips and Petrofski and their colleagues at Wright State. The text is primarily a series of articles that were published in various journals. It is organized into four parts: theory and background, stationary exercise rehabilitation, ambulatory exercise rehabilitation, and, finally, a section on the prescription for the use of functional electrical rehabilitation. In part 1, the author discusses the theory and descriptions of animal studies and experiments used in the development of computer programs for the contraction and movement of muscles. The engineering aspects of closed-loop control, including mathematic models and a review of the literature, are provided as well as its application to rehabilitative engineering, which focuses on electrical stimulation of paralyzed muscles. 721
© 1993 Mayo Foundation/or Medical Education and Research
722
Mayo CIiD Proc, July 1993, Vol 68
BOOK REVIEWS
In part 2, the effects of FES-induced stationary exercise are presented primarily from studies performed in the author's laboratories. Many of the experiments were controlled and participants were normal subjects and those with paraplegia and quadriplegia. Cardiovascular, pulmonary, and thermoregulatory responses to FES-induced stationary exercise are described. In part 3, the focus is on ambulation in patients with spinal cord injuries. This section includes not only stimulation of muscles but also necessary mechanisms of feedback and techniques of bracing. As in part 2, the response of human subjects and the effects of ambulation on the cardiovascular system and respiratory function are described. In addition, a section discusses the psychologic aspects and the effects of training with sensory feedback systems to help maintain balance in patients with spinal cord injuries. Part 4 is devoted to the prescription for FES. The author discusses commercially available components, medical criteria necessary for patients to participate in such a program, and needed follow-up. The final chapter is a program user's guide for functional electrical rehabilitation. As the author states in the preface, "this book has been written for a broad and diversified audience," including physicians of all disciplines who treat patients with spinal cord injuries, allied health-care professionals, exercise physiologists, biomechanical engineers, and, finally, patients who desire "state-of-the-art technology." This is not a textbook on the rehabilitation of patients with spinal cord injuries; rather, it is a collection of articles that discuss one facet of the broad field of rehabilitation of such patients. This publication contains useful information on the technical aspects of the use and effects of FES for exercise and ambulation in patients with spinal cord injuries. The chapter on medical criteria is particularly helpful. Jon B. Closson, M.D. Department of Physical Medicine and Rehabilitation
Complications in Head and Neck Surgery, edited by Yosef P. Krespi and Robert H. Ossoff, 582 pp, with illus, $85, Philadelphia, W. B. Saunders Company, 1993 Complications that can occur during head and neck surgical procedures constitute almost a fourth of the oral portion of the annual examination of the American Board of Otolaryngology-Head and Neck Surgery. This aspect of the field of otolaryngology is also carefully assessed in the written part of the boards in the fall of each year. Krespi and Ossoff's book, Complications in Head and Neck Surgery, consists of 31 chapters written by 59 contributors. It comprehensively reviews complications that can happen and their management. The material is well arranged, highly readable, and succinct as well as extremely well focused. The text initially discusses complications related to anesthesia and then incidents concerned with blood vessels. Subsequently, it addresses specific problems, beginning with the causes and management of all types of pharyngocutaneous fistulas. Finally, it
proceeds region by region to examine all potential complications that are encountered during surgical intervention of the head and neck, including those related to maxillofacial trauma, cancer management, cosmetic treatment, and procedures that involve the resection of tumors and reconstruction. Obviously, the authors are "in the trenches," a term that means that they encounter such problems day in and day out. They understand the complications, possible ways to prevent them, and management of them. Despite the positive aspects of the book, I would have liked a more in-depth discussion on shock and a better review of preoperative and postoperative care for major surgical procedures of the head and neck. In the section that addresses complications during tonsillectomies, I would have preferred an elaboration of malignant hyperthermia. Otherwise, this excellent book belongs on the desks of all practitioners, especially those in residency training. Thomas J. McDonald, M.D. Department of Otorhinolaryngology
Diseases of the External Eye and Adnexa: A Text and Atlas, by H. Bruce Ostler, 835 pp, with illus, $240, Baltimore, Williams & Wilkins, 1993 The many inflammatory, infectious, metabolic, and neoplastic disorders that affect the external eye and the tissues surrounding the globe may present diagnostic and therapeutic challenges not only to ophthalmologists but also to dermatologists, otolaryngologists, and primary-care physicians. Because such diseases often are diagnosed most readily by careful observation, this excellent photographic atlas is a notable contribution to the resource materials available to practitioners interested in these disorders. The book contains 15 chapters that constitute 2 major sections. The first section has a brief review of the basic principles of the management of diseases of the external eye and adnexa. Subsequently, chapters are presented on disorders arranged by the anatomic region affected: eyelid and lid margin, conjunctiva, cornea, episclera and sclera, lacrimal gland and lacrimal drainage system, and orbit. The second section deals primarily with infections by bacteria, chlamydia, rickettsiae, viruses, fungi, and parasites. It contains a chapter on ocular surface disorders and a lengthy chapter that reviews noninfectious and miscellaneous diseases. Additionally, the textbook includes a useful appendix on the appropriate administration of medications used in ophthalmology. The format of the text allows readers to obtain facts quickly. Most disorders are discussed in outline form-a short introduction and then paragraphs on immunology and pathogenesis, differential diagnosis, laboratory findings, pathologic features, management, and prognosis and sequelae. The book is liberally illustrated with photographs, almost all of which are in color and of superior quality. The references at the conclusion of each chapter are well chosen but not exhaustive. In summary, I highly recommend this work. George B. Bartley, M.D. Department of Ophthalmology
Disorders of the Pancreas: Current Issues in Diagnosis and Management, edited by Gerard P. Bums and Simmy Bank, 506 pp, with illus, $80, New York, McGraw-Hill, 1992 To quote Yogi Berra: "This is deja vu allover again." I was a fledgling student in a different country when I first encountered Dr. Bank, one of the editors of Disorders ofthe Pancreas. At that time, he was a stimulating educator and a catalyst of new ideas. Time has not changed these admirable abilities. Dr. Bank and his coeditor Dr. Bums have collated the talents and experiences of a group of dedicated pancreatologists (should they be called an islet?) from Mayo Clin Proc 1993; 68:721-725
various specialties and parts of the world. In the foreword, the editors are somewhat apologetic for the incompleteness of this contribution; this is one of the few mistakes encountered-the editors have no need to apologize because this text is an enticing and comprehensive pancreatic smorgasbord. All persons with an interest in the pancreas will find what they are looking for. If their interest is experimental, the intriguing issue of pancreatic regeneration is addressed by Dreiling; if their interest is radiologic, all aspects are covered in more than one chapter; and if their interest is either medical or surgical therapy, excellent contributions by Marks, Ranson, Warshaw, Thompson, Frey, Moosa, Anderson, Pitt, and Blumgart are provided. The important issue of pain management in pancreatic disorders is well covered as is adjuvant therapy for pancreatic malignant disease. For me, a highlight of reviewing this text was careful perusal of the editorial comments and statements of the controversy to be addressed that precede each chapter. These concise and insightful comments reflect the expertise and clear understanding of both editorial pancreatologists about the somewhat hidden, often feared, highly respected, and ubiquitous pancreas. All medical professionals who are responsible for the care of patients afflicted with diseases of the pancreas will enjoy this excellent contribution. Jon A. van Heerden, M.B.,Ch.B. Division of Gastroenterologic and General Surgery
Functional Electrical Rehabilitation: Technological Restoration After Spinal Cord Injury, by Chandler Allen Phillips, 209 pp, with illus, $98, New York, Springer-Verlag, 1991 One new technique in the rehabilitation of people with spinal cord injuries is electrical stimulation of paralyzed muscles. Functional electrical stimulation (FES) can be used to achieve several goals, including building muscle bulk in paralyzed muscles, improving cardiopulmonary fitness, and assisting with ambulation. This book describes the background and approach to the use of FES for lower extremities as it evolved in the programs at Wright State University. Most techniques presented have been done by Drs. Phillips and Petrofski and their colleagues at Wright State. The text is primarily a series of articles that were published in various journals. It is organized into four parts: theory and background, stationary exercise rehabilitation, ambulatory exercise rehabilitation, and, finally, a section on the prescription for the use of functional electrical rehabilitation. In part 1, the author discusses the theory and descriptions of animal studies and experiments used in the development of computer programs for the contraction and movement of muscles. The engineering aspects of closed-loop control, including mathematic models and a review of the literature, are provided as well as its application to rehabilitative engineering, which focuses on electrical stimulation of paralyzed muscles. 721
© 1993 Mayo Foundation/or Medical Education and Research
722
Mayo CIiD Proc, July 1993, Vol 68
BOOK REVIEWS
In part 2, the effects of FES-induced stationary exercise are presented primarily from studies performed in the author's laboratories. Many of the experiments were controlled and participants were normal subjects and those with paraplegia and quadriplegia. Cardiovascular, pulmonary, and thermoregulatory responses to FES-induced stationary exercise are described. In part 3, the focus is on ambulation in patients with spinal cord injuries. This section includes not only stimulation of muscles but also necessary mechanisms of feedback and techniques of bracing. As in part 2, the response of human subjects and the effects of ambulation on the cardiovascular system and respiratory function are described. In addition, a section discusses the psychologic aspects and the effects of training with sensory feedback systems to help maintain balance in patients with spinal cord injuries. Part 4 is devoted to the prescription for FES. The author discusses commercially available components, medical criteria necessary for patients to participate in such a program, and needed follow-up. The final chapter is a program user's guide for functional electrical rehabilitation. As the author states in the preface, "this book has been written for a broad and diversified audience," including physicians of all disciplines who treat patients with spinal cord injuries, allied health-care professionals, exercise physiologists, biomechanical engineers, and, finally, patients who desire "state-of-the-art technology." This is not a textbook on the rehabilitation of patients with spinal cord injuries; rather, it is a collection of articles that discuss one facet of the broad field of rehabilitation of such patients. This publication contains useful information on the technical aspects of the use and effects of FES for exercise and ambulation in patients with spinal cord injuries. The chapter on medical criteria is particularly helpful. Jon B. Closson, M.D. Department of Physical Medicine and Rehabilitation
Complications in Head and Neck Surgery, edited by Yosef P. Krespi and Robert H. Ossoff, 582 pp, with illus, $85, Philadelphia, W. B. Saunders Company, 1993 Complications that can occur during head and neck surgical procedures constitute almost a fourth of the oral portion of the annual examination of the American Board of Otolaryngology-Head and Neck Surgery. This aspect of the field of otolaryngology is also carefully assessed in the written part of the boards in the fall of each year. Krespi and Ossoff's book, Complications in Head and Neck Surgery, consists of 31 chapters written by 59 contributors. It comprehensively reviews complications that can happen and their management. The material is well arranged, highly readable, and succinct as well as extremely well focused. The text initially discusses complications related to anesthesia and then incidents concerned with blood vessels. Subsequently, it addresses specific problems, beginning with the causes and management of all types of pharyngocutaneous fistulas. Finally, it
proceeds region by region to examine all potential complications that are encountered during surgical intervention of the head and neck, including those related to maxillofacial trauma, cancer management, cosmetic treatment, and procedures that involve the resection of tumors and reconstruction. Obviously, the authors are "in the trenches," a term that means that they encounter such problems day in and day out. They understand the complications, possible ways to prevent them, and management of them. Despite the positive aspects of the book, I would have liked a more in-depth discussion on shock and a better review of preoperative and postoperative care for major surgical procedures of the head and neck. In the section that addresses complications during tonsillectomies, I would have preferred an elaboration of malignant hyperthermia. Otherwise, this excellent book belongs on the desks of all practitioners, especially those in residency training. Thomas J. McDonald, M.D. Department of Otorhinolaryngology
Diseases of the External Eye and Adnexa: A Text and Atlas, by H. Bruce Ostler, 835 pp, with illus, $240, Baltimore, Williams & Wilkins, 1993 The many inflammatory, infectious, metabolic, and neoplastic disorders that affect the external eye and the tissues surrounding the globe may present diagnostic and therapeutic challenges not only to ophthalmologists but also to dermatologists, otolaryngologists, and primary-care physicians. Because such diseases often are diagnosed most readily by careful observation, this excellent photographic atlas is a notable contribution to the resource materials available to practitioners interested in these disorders. The book contains 15 chapters that constitute 2 major sections. The first section has a brief review of the basic principles of the management of diseases of the external eye and adnexa. Subsequently, chapters are presented on disorders arranged by the anatomic region affected: eyelid and lid margin, conjunctiva, cornea, episclera and sclera, lacrimal gland and lacrimal drainage system, and orbit. The second section deals primarily with infections by bacteria, chlamydia, rickettsiae, viruses, fungi, and parasites. It contains a chapter on ocular surface disorders and a lengthy chapter that reviews noninfectious and miscellaneous diseases. Additionally, the textbook includes a useful appendix on the appropriate administration of medications used in ophthalmology. The format of the text allows readers to obtain facts quickly. Most disorders are discussed in outline form-a short introduction and then paragraphs on immunology and pathogenesis, differential diagnosis, laboratory findings, pathologic features, management, and prognosis and sequelae. The book is liberally illustrated with photographs, almost all of which are in color and of superior quality. The references at the conclusion of each chapter are well chosen but not exhaustive. In summary, I highly recommend this work. George B. Bartley, M.D. Department of Ophthalmology