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Therapy for Stroke: Building on Experience
307
Therapy for Stroke: ~uildingon Experience Margaret Johnstone FCSF! Churchill :Lingstone, Edinburgh, 1991 (ISBN 0 443 04625 5). Illus. 116 pages. f9.95.
As this is Margaret Johnstone’s fourth book on stroke rehabilitation, her aim has been ‘to answer some outstanding questions’. The book is not designed as a comprehensive text in its own right, but rather to complement previous publications. The author’s wealth of experience in treating stroke patients, and in particular her expertise in the use of pressure splints, is a strong feature of the book. The text is clearly written with good definition of important terms, and a glossary a t the end. The first two chapters deal with basic neurology and the application of neurological principles t o the treatment of stroke. It is disappointing, a t a time when other authors are trying to base their texts on the available scientific literature, that Margaret Johnstone includes no references other t h a n her own publications. Research studies undertaken by the author are cited. However,
insufficient data and lack of references leave readers in no position to judge the efficacy of the treatment approach for themselves. The remainder of the book is devoted to clinical issues including assessment, a n update on pressure splints, and specific problems related to treatment. The final chapter is a case history to illustrate the use of pressure techniques. Some of the ideas may well be considered controversial, including the use of early developmenal patterns of movement. Much emphasis is placed on early weight-bearing, particularly through the arm, and it is of concern that insufficient guidance is given on correct alignment of the shoulder complex, and its accompanying risks. Some may also find it disappointing that guide lines for treatment are still too prescriptive, rather than encouraging the therapist to diagnose and problem-solve. The book is an interesting contribution to neurological physiotherapy, but disappointing in its lack of scientific content.
Nina Melville MCSP
An illustration from ‘Therapyfor Stroke’ comparing the whole working wheel with the whole man - the hub is the central support. Damage to the hub will cause collapse of the spokes; damage to the neurological working of the trunk causes the man to collapse Neither wheel nor man can function normally without central stability.
The Practical Management of Spasticity in Children and Adults by Me/ B Glenn and John Whyie. Lea and kbigec Philadelphia and London, 1990 (ISBN 0 8121 1297 0).Illus. 325 pages. f26.75.
This book deals with t h e problems of spasticity in a range of childhood and adult neurological disorders and aims to immove understanding of the full spectrum of treatments available and the ‘state of the art’ in each discipline. There is a n impressive array of contributors, mainly professors and therapists from Tufts University School of Medicine, Boston, and the Drucker Brain Injury Center, Philadelphia. The neurophysiology of spasticity is described in great depth and is not for the
faint-hearted, with a detailed review of research and explanations of associated phenomena and the attending impairment of voluntary movements. There is an interesting chapter on motor learning and relearning, including some recent research on therapeutic exercises. However, only three major ‘schools of thought’ are discussed and compared: PNF, the Bobath approach and the Brunnstrom approach. Other chapters cover evaluation of spasticity and its effects on motor function, positioning, casting, splinting and orthotics, drugs, nerve blocks, neurosurgical and orthopaedic procedures, all well-illustrated and referenced. The section on physical modalities gives some interesting suggestions for adjuncts to
Power in Caring Professions by Richard Hugman. Macmillan, Basingstoke, 1991 (ISBN 0 333 49855 0).250 pages. f9.99 paperback.
In the first chapter Richard Hugman sets out the key questions to be addressed in the book. These centre around the degree to which caring professions are produced through power relationships a t both the interpersonal and structural levels; the ways in which issues of power relate to the historical development and contemporary structures of the caring professions; the way relationships between professionals and service users and between different professional groups create and maintain forms of power; and the possibilities for the future of the caring professions based on an analysis on the idea of power. The limitations of using the trait theory for analysing professionalisation are discussed and the author justifies his reasons for discarding this approach and argues for using power relationships for his analysis. Succeeding chapters deal with the professions and the State; dimensions of power, professions and hierarchy; the struggle for professionalism; relationships with clients; racism and gender. The material is well researched and recent literature as well as the established texts on professionalism are cited. Each topic is treated in depth and conclusions are well justified by argument based on the literature and the author’s own theories. Throughout the book there are references to physiotherapy and its development. The book should be of interest to anyone studying professions from a sociological perspective. I could not, however, fully agree with the claim on the back cover ‘that it would be essential reading for all those studying to work in the caring professions’. It would have been helpful if summaries of the main points had been provided a t the end of each chapter. No doubt future editions of the book will analyse the effect that the introduction of ‘general management’ and other changes in the health service have had on the power of the professions.
Patricia McCoy MEd MCSP
the ‘therapeutic exercise program’ including electrical stimulation, vibration, biofeedback and acupuncture, with clear rationale for the possible facilitatory, excitatory or inhibitory effects of each modality. Although this book is limited to a scientific study of one syndrome of neurological damage and far from the sort of holistic approach generally advocated, it is very informative, practical and thought provoking and would be particularly helpful to anyone specialising in this area or embarking on research. It would be a useful reference book for medical and therapy staff in paediatric and adult neurology departments.
Carole Hurran BA GradDipPhys MCSP
Physiotherapy, April 1992, V O l 7 8 , no 4
Therapy for Stroke: ~uildingon Experience Margaret Johnstone FCSF! Churchill :Lingstone, Edinburgh, 1991 (ISBN 0 443 04625 5). Illus. 116 pages. f9.95.
As this is Margaret Johnstone’s fourth book on stroke rehabilitation, her aim has been ‘to answer some outstanding questions’. The book is not designed as a comprehensive text in its own right, but rather to complement previous publications. The author’s wealth of experience in treating stroke patients, and in particular her expertise in the use of pressure splints, is a strong feature of the book. The text is clearly written with good definition of important terms, and a glossary a t the end. The first two chapters deal with basic neurology and the application of neurological principles t o the treatment of stroke. It is disappointing, a t a time when other authors are trying to base their texts on the available scientific literature, that Margaret Johnstone includes no references other t h a n her own publications. Research studies undertaken by the author are cited. However,
insufficient data and lack of references leave readers in no position to judge the efficacy of the treatment approach for themselves. The remainder of the book is devoted to clinical issues including assessment, a n update on pressure splints, and specific problems related to treatment. The final chapter is a case history to illustrate the use of pressure techniques. Some of the ideas may well be considered controversial, including the use of early developmenal patterns of movement. Much emphasis is placed on early weight-bearing, particularly through the arm, and it is of concern that insufficient guidance is given on correct alignment of the shoulder complex, and its accompanying risks. Some may also find it disappointing that guide lines for treatment are still too prescriptive, rather than encouraging the therapist to diagnose and problem-solve. The book is an interesting contribution to neurological physiotherapy, but disappointing in its lack of scientific content.
Nina Melville MCSP
An illustration from ‘Therapyfor Stroke’ comparing the whole working wheel with the whole man - the hub is the central support. Damage to the hub will cause collapse of the spokes; damage to the neurological working of the trunk causes the man to collapse Neither wheel nor man can function normally without central stability.
The Practical Management of Spasticity in Children and Adults by Me/ B Glenn and John Whyie. Lea and kbigec Philadelphia and London, 1990 (ISBN 0 8121 1297 0).Illus. 325 pages. f26.75.
This book deals with t h e problems of spasticity in a range of childhood and adult neurological disorders and aims to immove understanding of the full spectrum of treatments available and the ‘state of the art’ in each discipline. There is a n impressive array of contributors, mainly professors and therapists from Tufts University School of Medicine, Boston, and the Drucker Brain Injury Center, Philadelphia. The neurophysiology of spasticity is described in great depth and is not for the
faint-hearted, with a detailed review of research and explanations of associated phenomena and the attending impairment of voluntary movements. There is an interesting chapter on motor learning and relearning, including some recent research on therapeutic exercises. However, only three major ‘schools of thought’ are discussed and compared: PNF, the Bobath approach and the Brunnstrom approach. Other chapters cover evaluation of spasticity and its effects on motor function, positioning, casting, splinting and orthotics, drugs, nerve blocks, neurosurgical and orthopaedic procedures, all well-illustrated and referenced. The section on physical modalities gives some interesting suggestions for adjuncts to
Power in Caring Professions by Richard Hugman. Macmillan, Basingstoke, 1991 (ISBN 0 333 49855 0).250 pages. f9.99 paperback.
In the first chapter Richard Hugman sets out the key questions to be addressed in the book. These centre around the degree to which caring professions are produced through power relationships a t both the interpersonal and structural levels; the ways in which issues of power relate to the historical development and contemporary structures of the caring professions; the way relationships between professionals and service users and between different professional groups create and maintain forms of power; and the possibilities for the future of the caring professions based on an analysis on the idea of power. The limitations of using the trait theory for analysing professionalisation are discussed and the author justifies his reasons for discarding this approach and argues for using power relationships for his analysis. Succeeding chapters deal with the professions and the State; dimensions of power, professions and hierarchy; the struggle for professionalism; relationships with clients; racism and gender. The material is well researched and recent literature as well as the established texts on professionalism are cited. Each topic is treated in depth and conclusions are well justified by argument based on the literature and the author’s own theories. Throughout the book there are references to physiotherapy and its development. The book should be of interest to anyone studying professions from a sociological perspective. I could not, however, fully agree with the claim on the back cover ‘that it would be essential reading for all those studying to work in the caring professions’. It would have been helpful if summaries of the main points had been provided a t the end of each chapter. No doubt future editions of the book will analyse the effect that the introduction of ‘general management’ and other changes in the health service have had on the power of the professions.
Patricia McCoy MEd MCSP
the ‘therapeutic exercise program’ including electrical stimulation, vibration, biofeedback and acupuncture, with clear rationale for the possible facilitatory, excitatory or inhibitory effects of each modality. Although this book is limited to a scientific study of one syndrome of neurological damage and far from the sort of holistic approach generally advocated, it is very informative, practical and thought provoking and would be particularly helpful to anyone specialising in this area or embarking on research. It would be a useful reference book for medical and therapy staff in paediatric and adult neurology departments.
Carole Hurran BA GradDipPhys MCSP
Physiotherapy, April 1992, V O l 7 8 , no 4