- Email: [email protected]
Rehabilitation in Parkinson's Disease
3. Time Scale
Contra-indications
T h e initial t r e a t m e n t p e r i o d is usually f i v e t o t e n minutes, o f t e n with reassessment being carried o u t h a l f - w a y t h r o u g h t h e t r e a t m e n t period. S u b s e q u e n t sessions are u s u a l l y t e n t o t w e n t y m i n u t e s w i t h o u t interruption. T h i s p e r i o d o f t r e a t m e n t is significantly longer t h a n m o s t t r e a t m e n t s b y passive mobilisation, a n d is, i n m y opinion, a m a j o r f a c t o r i n t h e g o o d i m p r o v e m e n t i n range of m o v e m e n t obtained. Soreness f o l l o w i n g t r e a t m e n t is relatively u n c o m m o n .
Cervical t r a c t i o n with a c t i v e r o t a t i o n would not b e r e c o m m e n d e d for u s e w h e r e t h e r e i s a n y possibility of undiagnosed fracture; in t h e presence o f c o r d signs, vertebral a r t e r y disease, o r in p a t i e n t s s u f f e r i n g f r o m drop a t t a c k s o r r h e u m a t o i d arthritis. It i s unlikely to s u c c e e d if cervical r o t a t i o n c a u s e s o r increases referred pain. Care s h o u l d b e t a k e n in t h e p r e s e n c e o f spasm, epilepsy o r possible osteoporosis.
4. Combination of Traction and Active Movement
Conclusion
T h i s c o m b i n a t i o n is t h e u n i q u e feature o f t h i s t r e a t m e n t
and p o s s i b l y t h e key to its success. Patients o f t e n describe t h e sensation o f ' t h e w e i g h t being taken off their shoulders'. Distraction of joint surfaces m a k e n e c k movements freer and m o r e comfortable. T h i s enables p a t i e n t s t o o b t a i n t h e i m p r o v e m e n t in r a n g e w h i c h c a n t h e n be m a i n t a i n e d by a c t i v e exercise a t h o m e .
T h e t r e a t m e n t o f cervical t r a c t i o n with a c t i v e r o t a t i o n proved s u c c e s s f u l f o r t h i s p a t i e n t f o l l o w i n g l i m i t e d benefit f r o m m o r e c o n v e n t i o n a l t r e a t m e n t . The a u t h o r is hoping t o u n d e r t a k e a f o r m a l research p r o j e c t to examine t h i s t e c h n i q u e in t h e near future.
Indications
As described, t h e technique o f cervical traction with active rotation c a n b e u s e d successfully with degenerative cervical conditions. It h a s also p r o v e d useful, i n my experience, with f a c e t j o i n t disorders a n d s u b a c u t e whiplash.
ACKNOWLEDGMENTS The author would like to thank her patient for agreeing to the case study, Mrs R Rogers MCSP the original 'guinea pig', and Mr K Cox MCSP for his comments and support.
book review The Effect of Several Physiotherapeutic Int e r ve nt io ns Tr a c he o b r o n c h i a I on Clearance, by M van Hengstum. Thesis Publishers, Bickersgracht 60, 1013 LG Amsterdam, The Netherlands, 1990 (ISBN 90 5170 038 5). Illus. 96 pages. Dfl 29.50 or USS17. The central theme of this book is tracheobronchial clearance, and i t presents a series of work on this subject completed by the author, a Dutch chest physician. This work is not entirely confined t o physiotherapeutic interventions and therefore the book title is a little misleading. The first chapter reviews the literature on tracheobronchial clearance in health and disease, and the ways of effectively measuring this. Chapters 2 t o 8 bring together previously published papers, reproduced in full. The topics include the variability of clearance in healthy subjects, comparisons of the forced expiration technique (FET) and positive expiratory pressure (PEP1 in chronic bronchitis, FET w i t h high frequency oscillation in chronic bronchitis, the effect of sauna on clearance, and clearance in patients with dextrocardia. The book concludes w i t h a discussion of the findings of the studies and a summary of each. This publication contributes t o the current information on sputum clearance, in evaluating various modes of treatment currently in use. However, one must bear in mind that most of these physiotherapy treatment studies were done on patients w i t h chronic bronchitis rather than cystic fibrosis which is more usual, and a major criticism of the studies is that fewer than
784
ten patients are included in each one. The book, however, is reasonably well written and concise, and would provide useful reading for anyone involved particularly w i t h chronic respiratory conditions. I would recommend it for inclusion in school and departmental libraries, t o be read in conjunction with other work on this subject. M ANDREWS MCSP Treating Sports Injuries the Natural Way: A homoeopathic self-treatment handbook, by Lyle W Morgan PhD. Thorsons, London, 1990 (ISBN 0 7225 1604 5). 116 pages.
f4.99.
This paperback is situated at the better end of a row of seemingly endless books on the treatment of injured sportspeople using natural methods. When the complementary medicine approach t o treatments burst on the scene a f e w years ago it seemed that the floodgates opened and a lot of trivia have been published since, much of which are old hat t o complementary practitioners but some of which may be new t o Chartered physiotherapists. Dr Morgan is very methodical with his chapters, allowing sections on the treatment of all forms of soft tissue lesions, fractures, joint instabilities and spinal lesions. He dwells too much on the clinical practice with the use of homoeopathy, which is fine if you happen t o be a homoeopath but not if you are not. Only the rudimentary basics of the homoeopathic approach are dealt with, whereas it is such a vast subject that more time needs t o be spent on this. Also w e are
not told where w e can obtain the remedies or indeed if there is any clinical evidence t o substantiate the claims of healing. More emphasis, one feels, is needed t o explain the other many and variobs complementary medicine approaches t o the treatment of sports injuries, such as acupressure, reflexology, herbs, etc. Such a book that is aimed at the medical professional is sorely needed. On the whole though, I enjoyed reading this book and would certainly recommend it to any physiotherapist who wants t o learn the basics of this different approach. JOHN R CROSS MCSP Rehabilitation in Parkinson's Disease, edited by Francis I Caird. Therapy in Practice 25. Chapman and Hall, London, 1991 (ISBN 0 412 34600 1). Illus. 134 pages. f10.95. This book, which is really a collection of articles by various authors, is aimed at all those concerned w i t h the rehabilitation of Parkinson's disease patients. According t o Dr Caird the book aims t o convey the importance of team effort in order effectively to help those patients w i t h their problems. The contributors t o this book have concentrated on the principles of treatment and management rather than the complex neuroscience of the disease. The respective roles of the nurse, occupational therapist, physiotherapist, social worker, speech therapist and how they can all work together are discussed. Moira Banks has written an excellent chapter on physiotherapy and there are also very interesting chapters by Dr B Pentland on drug therapy, Barbara
Physiotherapy, November 1991,vol 77, no 7 7
Sharp on nursing care and Sheila Scott on speech therapy. Other subjects include Parkinson's disease and its natural history, occupational therapy, and social work. There is information about the Parkinson's Disease Society and a list of useful addresses. Overall, I enjoyed reading this book which was u p t o date, clear, concise and informative. It is a very useful text book for all those learning about and treating Parkinson's disease patients. FELICITY HANDFORD MCSP
Skeletal Muscle in Health and Disease: A textbook of muscle physiology, by David A Jones and Joan M Round. Manchester University Press, 1 9 9 0 (ISBN 0 71 9 0 31 6 3 X hardback, ISBN 0 7 1 9 0 3 1 6 4 8 paperback). Illus. 2 2 1 pages. € 2 9 . 9 5 hardback, € 9 . 9 5 paperback. The authors have set out very clear objectives t o provide a textbook of basic muscle physiology that includes topics of current research interest and at the same time introducing the reader t o clinical physiology through the section on muscle disease. The topics in this book have been very carefully selected t o be of maximal value t o those readers w h o are particularly interested in exercise muscle physiology. There are many books written about exercise physiology but these are usually large tomes dealing with a very complex integration of inter-related systems from which it is usually difficult t o extricate the physiology of any individual system or tissue. The first four chapters on structure, mechanics and muscleinerve interactions are clearly explained and amply illustrated with relatively simple diagrams and highly magnified, well-labelled microscopic sections. The clarity and simplicity of the diagrams would encourage any student t o replicate them when describing these physiological activities. The book n o w moves t o g r o w t h ,
Communicating Quality - Professional Standards for Speech and Language Therapists, by Tessa Smith, Guidelines Project Director. College of Speech and Language Therapists, 1 9 9 1 (ISBN 0 9 4 7 5 8 9 0 1 51. 2 9 9 pages. € 2 7 . 9 5 (application form from CSLT, 6 Lechmere Road, London NW2 5BU). This beautifully produced book provides a guide t o good practice for speech and language therapists and aspires to be a guide f o r commissioning authorities and consumers. Not only are various service locations, client and service groups and
development and ageing of muscle in which strength and muscle mass is discussed in relation t o function including the use of anabolic drugs. The subsequent chapters on muscle training for power and endurance, muscle fatigue, damage and pain are very relevant t o the physiotherapist. The concepts cover a wide sphere of muscular activity ranging f r o m such everyday activities as rising from a chair to the more strenuous activity of marathon running. The final section is concerned with muscle diseases and demonstrates h o w a knowledge of muscle physiology underpins an understanding of the disease process. I have found this book to be extremely useful, interesting and readable. The information given is valuable in itself, but, at the same time 'whets one's appetite' t o seek further knowledge and provides the necessary references and ideas for further reading at the end of each chapter. With escalating costs and the rapid growth of new books it is difficult t o suggest that this should be an essential textbook for students, but, there should be multiple copies in school libraries. Individuals interested in specialising in sports medicine, and physiotherapy departments, would find purchase of this book a worth-while investment A JEAN BELL M A MCSP DipTP
Motor neurones
7
Peripheral nerve
Axonal
Cell body
The concept of the motor unit. A motor unir consists o f the motoneurone and a// the scattered muscle fibres which it innervates. A diagram from 'Skeletal Muscle in Healrh and Disease'
Physiotherapy, November 1991, vol 77, no 1 1
presenting disorders covered but also areas of professional development, management and skill mix. The last t w o chapters provide useful guide lines for independent ptactitioners and health promotion. There is no guide as t o the use of the different coloured print within the book. The detail presented in the first three chapters is somewhat repetitive and overlaps, making it difficult to see how such duplication facilitates the understanding of these services. Standards vary from being very precise and descriptive, for example, giving exact time periods within which referrals should be assessed, and fairly nonspecific about actual interventions or assessment procedures. In view of the national shortage of speech therapists it will be interesting t o see whether or not these standards can be upheld. As the language within the book is particular t o that professional jargon it is difficult t o know what the users would be able to glean from it. There is an excellent chapter on working within a legal framework covering a wide variety of issues. Professional development and management chapters can in many ways be applied t o many professions within the Health Service. The brief skill mix chapter does not cross professional boundaries but gives a good description of the various rules within speech therapy. Although this book will be of undoubted great benefit t o speech and language therapists I am unsure as t o h o w useful other professions, or indeed users, will find it. ANN HUNTER MCSP A n Anatomical Wordbook by Stephen Lewis. Butterworth-Heinemann, London, 1 9 9 0 (ISBN 0 7506 1 0 2 3 9 ) . 1 3 4 pages. €4.95. I enjoyed sampling the pages of this little book, pausing as terms caught m y eye, smiling in recognition here and raising eyebrows there as something quite new held my attention. I never sought the derivation of the word 'anatomy' but n o w appreciate how apt it was for early students of the subject; maybe physiotherapists, with their accent on the living body should coin a new word. The book is what it claims and is likely t o achieve what it sets out t o do - t o lighten the labour of anatomical study by showing that very many words are self-explanatory in terms of function, position, shape and so forth. The preface states: 'If as is said "every picture tells a story" then happily, in anatomy, "every word is a picture".' I had expected an anatomical dictionary but found rather more. Prefixes and suffixes: '-oids', '-iforms', and '-ates' are given attention and successive pages deal w i t h bones, muscles, cranial nerves, joint types and terms of space and action. A glossary forms two-thirds of the book which concludes w i t h some delightful potted biographies. M y apologies t o Julius Wolff for not acknowledging his law t o my students. The print is clear, contrasting typefaces are well used and the sections simply organised. Recommended for teachers who wish t o enlighten and students who desire to understand.
DAVID J WARD MCSP DipTP
785
Contra-indications
T h e initial t r e a t m e n t p e r i o d is usually f i v e t o t e n minutes, o f t e n with reassessment being carried o u t h a l f - w a y t h r o u g h t h e t r e a t m e n t period. S u b s e q u e n t sessions are u s u a l l y t e n t o t w e n t y m i n u t e s w i t h o u t interruption. T h i s p e r i o d o f t r e a t m e n t is significantly longer t h a n m o s t t r e a t m e n t s b y passive mobilisation, a n d is, i n m y opinion, a m a j o r f a c t o r i n t h e g o o d i m p r o v e m e n t i n range of m o v e m e n t obtained. Soreness f o l l o w i n g t r e a t m e n t is relatively u n c o m m o n .
Cervical t r a c t i o n with a c t i v e r o t a t i o n would not b e r e c o m m e n d e d for u s e w h e r e t h e r e i s a n y possibility of undiagnosed fracture; in t h e presence o f c o r d signs, vertebral a r t e r y disease, o r in p a t i e n t s s u f f e r i n g f r o m drop a t t a c k s o r r h e u m a t o i d arthritis. It i s unlikely to s u c c e e d if cervical r o t a t i o n c a u s e s o r increases referred pain. Care s h o u l d b e t a k e n in t h e p r e s e n c e o f spasm, epilepsy o r possible osteoporosis.
4. Combination of Traction and Active Movement
Conclusion
T h i s c o m b i n a t i o n is t h e u n i q u e feature o f t h i s t r e a t m e n t
and p o s s i b l y t h e key to its success. Patients o f t e n describe t h e sensation o f ' t h e w e i g h t being taken off their shoulders'. Distraction of joint surfaces m a k e n e c k movements freer and m o r e comfortable. T h i s enables p a t i e n t s t o o b t a i n t h e i m p r o v e m e n t in r a n g e w h i c h c a n t h e n be m a i n t a i n e d by a c t i v e exercise a t h o m e .
T h e t r e a t m e n t o f cervical t r a c t i o n with a c t i v e r o t a t i o n proved s u c c e s s f u l f o r t h i s p a t i e n t f o l l o w i n g l i m i t e d benefit f r o m m o r e c o n v e n t i o n a l t r e a t m e n t . The a u t h o r is hoping t o u n d e r t a k e a f o r m a l research p r o j e c t to examine t h i s t e c h n i q u e in t h e near future.
Indications
As described, t h e technique o f cervical traction with active rotation c a n b e u s e d successfully with degenerative cervical conditions. It h a s also p r o v e d useful, i n my experience, with f a c e t j o i n t disorders a n d s u b a c u t e whiplash.
ACKNOWLEDGMENTS The author would like to thank her patient for agreeing to the case study, Mrs R Rogers MCSP the original 'guinea pig', and Mr K Cox MCSP for his comments and support.
book review The Effect of Several Physiotherapeutic Int e r ve nt io ns Tr a c he o b r o n c h i a I on Clearance, by M van Hengstum. Thesis Publishers, Bickersgracht 60, 1013 LG Amsterdam, The Netherlands, 1990 (ISBN 90 5170 038 5). Illus. 96 pages. Dfl 29.50 or USS17. The central theme of this book is tracheobronchial clearance, and i t presents a series of work on this subject completed by the author, a Dutch chest physician. This work is not entirely confined t o physiotherapeutic interventions and therefore the book title is a little misleading. The first chapter reviews the literature on tracheobronchial clearance in health and disease, and the ways of effectively measuring this. Chapters 2 t o 8 bring together previously published papers, reproduced in full. The topics include the variability of clearance in healthy subjects, comparisons of the forced expiration technique (FET) and positive expiratory pressure (PEP1 in chronic bronchitis, FET w i t h high frequency oscillation in chronic bronchitis, the effect of sauna on clearance, and clearance in patients with dextrocardia. The book concludes w i t h a discussion of the findings of the studies and a summary of each. This publication contributes t o the current information on sputum clearance, in evaluating various modes of treatment currently in use. However, one must bear in mind that most of these physiotherapy treatment studies were done on patients w i t h chronic bronchitis rather than cystic fibrosis which is more usual, and a major criticism of the studies is that fewer than
784
ten patients are included in each one. The book, however, is reasonably well written and concise, and would provide useful reading for anyone involved particularly w i t h chronic respiratory conditions. I would recommend it for inclusion in school and departmental libraries, t o be read in conjunction with other work on this subject. M ANDREWS MCSP Treating Sports Injuries the Natural Way: A homoeopathic self-treatment handbook, by Lyle W Morgan PhD. Thorsons, London, 1990 (ISBN 0 7225 1604 5). 116 pages.
f4.99.
This paperback is situated at the better end of a row of seemingly endless books on the treatment of injured sportspeople using natural methods. When the complementary medicine approach t o treatments burst on the scene a f e w years ago it seemed that the floodgates opened and a lot of trivia have been published since, much of which are old hat t o complementary practitioners but some of which may be new t o Chartered physiotherapists. Dr Morgan is very methodical with his chapters, allowing sections on the treatment of all forms of soft tissue lesions, fractures, joint instabilities and spinal lesions. He dwells too much on the clinical practice with the use of homoeopathy, which is fine if you happen t o be a homoeopath but not if you are not. Only the rudimentary basics of the homoeopathic approach are dealt with, whereas it is such a vast subject that more time needs t o be spent on this. Also w e are
not told where w e can obtain the remedies or indeed if there is any clinical evidence t o substantiate the claims of healing. More emphasis, one feels, is needed t o explain the other many and variobs complementary medicine approaches t o the treatment of sports injuries, such as acupressure, reflexology, herbs, etc. Such a book that is aimed at the medical professional is sorely needed. On the whole though, I enjoyed reading this book and would certainly recommend it to any physiotherapist who wants t o learn the basics of this different approach. JOHN R CROSS MCSP Rehabilitation in Parkinson's Disease, edited by Francis I Caird. Therapy in Practice 25. Chapman and Hall, London, 1991 (ISBN 0 412 34600 1). Illus. 134 pages. f10.95. This book, which is really a collection of articles by various authors, is aimed at all those concerned w i t h the rehabilitation of Parkinson's disease patients. According t o Dr Caird the book aims t o convey the importance of team effort in order effectively to help those patients w i t h their problems. The contributors t o this book have concentrated on the principles of treatment and management rather than the complex neuroscience of the disease. The respective roles of the nurse, occupational therapist, physiotherapist, social worker, speech therapist and how they can all work together are discussed. Moira Banks has written an excellent chapter on physiotherapy and there are also very interesting chapters by Dr B Pentland on drug therapy, Barbara
Physiotherapy, November 1991,vol 77, no 7 7
Sharp on nursing care and Sheila Scott on speech therapy. Other subjects include Parkinson's disease and its natural history, occupational therapy, and social work. There is information about the Parkinson's Disease Society and a list of useful addresses. Overall, I enjoyed reading this book which was u p t o date, clear, concise and informative. It is a very useful text book for all those learning about and treating Parkinson's disease patients. FELICITY HANDFORD MCSP
Skeletal Muscle in Health and Disease: A textbook of muscle physiology, by David A Jones and Joan M Round. Manchester University Press, 1 9 9 0 (ISBN 0 71 9 0 31 6 3 X hardback, ISBN 0 7 1 9 0 3 1 6 4 8 paperback). Illus. 2 2 1 pages. € 2 9 . 9 5 hardback, € 9 . 9 5 paperback. The authors have set out very clear objectives t o provide a textbook of basic muscle physiology that includes topics of current research interest and at the same time introducing the reader t o clinical physiology through the section on muscle disease. The topics in this book have been very carefully selected t o be of maximal value t o those readers w h o are particularly interested in exercise muscle physiology. There are many books written about exercise physiology but these are usually large tomes dealing with a very complex integration of inter-related systems from which it is usually difficult t o extricate the physiology of any individual system or tissue. The first four chapters on structure, mechanics and muscleinerve interactions are clearly explained and amply illustrated with relatively simple diagrams and highly magnified, well-labelled microscopic sections. The clarity and simplicity of the diagrams would encourage any student t o replicate them when describing these physiological activities. The book n o w moves t o g r o w t h ,
Communicating Quality - Professional Standards for Speech and Language Therapists, by Tessa Smith, Guidelines Project Director. College of Speech and Language Therapists, 1 9 9 1 (ISBN 0 9 4 7 5 8 9 0 1 51. 2 9 9 pages. € 2 7 . 9 5 (application form from CSLT, 6 Lechmere Road, London NW2 5BU). This beautifully produced book provides a guide t o good practice for speech and language therapists and aspires to be a guide f o r commissioning authorities and consumers. Not only are various service locations, client and service groups and
development and ageing of muscle in which strength and muscle mass is discussed in relation t o function including the use of anabolic drugs. The subsequent chapters on muscle training for power and endurance, muscle fatigue, damage and pain are very relevant t o the physiotherapist. The concepts cover a wide sphere of muscular activity ranging f r o m such everyday activities as rising from a chair to the more strenuous activity of marathon running. The final section is concerned with muscle diseases and demonstrates h o w a knowledge of muscle physiology underpins an understanding of the disease process. I have found this book to be extremely useful, interesting and readable. The information given is valuable in itself, but, at the same time 'whets one's appetite' t o seek further knowledge and provides the necessary references and ideas for further reading at the end of each chapter. With escalating costs and the rapid growth of new books it is difficult t o suggest that this should be an essential textbook for students, but, there should be multiple copies in school libraries. Individuals interested in specialising in sports medicine, and physiotherapy departments, would find purchase of this book a worth-while investment A JEAN BELL M A MCSP DipTP
Motor neurones
7
Peripheral nerve
Axonal
Cell body
The concept of the motor unit. A motor unir consists o f the motoneurone and a// the scattered muscle fibres which it innervates. A diagram from 'Skeletal Muscle in Healrh and Disease'
Physiotherapy, November 1991, vol 77, no 1 1
presenting disorders covered but also areas of professional development, management and skill mix. The last t w o chapters provide useful guide lines for independent ptactitioners and health promotion. There is no guide as t o the use of the different coloured print within the book. The detail presented in the first three chapters is somewhat repetitive and overlaps, making it difficult to see how such duplication facilitates the understanding of these services. Standards vary from being very precise and descriptive, for example, giving exact time periods within which referrals should be assessed, and fairly nonspecific about actual interventions or assessment procedures. In view of the national shortage of speech therapists it will be interesting t o see whether or not these standards can be upheld. As the language within the book is particular t o that professional jargon it is difficult t o know what the users would be able to glean from it. There is an excellent chapter on working within a legal framework covering a wide variety of issues. Professional development and management chapters can in many ways be applied t o many professions within the Health Service. The brief skill mix chapter does not cross professional boundaries but gives a good description of the various rules within speech therapy. Although this book will be of undoubted great benefit t o speech and language therapists I am unsure as t o h o w useful other professions, or indeed users, will find it. ANN HUNTER MCSP A n Anatomical Wordbook by Stephen Lewis. Butterworth-Heinemann, London, 1 9 9 0 (ISBN 0 7506 1 0 2 3 9 ) . 1 3 4 pages. €4.95. I enjoyed sampling the pages of this little book, pausing as terms caught m y eye, smiling in recognition here and raising eyebrows there as something quite new held my attention. I never sought the derivation of the word 'anatomy' but n o w appreciate how apt it was for early students of the subject; maybe physiotherapists, with their accent on the living body should coin a new word. The book is what it claims and is likely t o achieve what it sets out t o do - t o lighten the labour of anatomical study by showing that very many words are self-explanatory in terms of function, position, shape and so forth. The preface states: 'If as is said "every picture tells a story" then happily, in anatomy, "every word is a picture".' I had expected an anatomical dictionary but found rather more. Prefixes and suffixes: '-oids', '-iforms', and '-ates' are given attention and successive pages deal w i t h bones, muscles, cranial nerves, joint types and terms of space and action. A glossary forms two-thirds of the book which concludes w i t h some delightful potted biographies. M y apologies t o Julius Wolff for not acknowledging his law t o my students. The print is clear, contrasting typefaces are well used and the sections simply organised. Recommended for teachers who wish t o enlighten and students who desire to understand.
DAVID J WARD MCSP DipTP
785